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The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making

The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making
The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making
Introduction
Evidence based guidelines for the optimal management of breast cancer locoregional recurrence (LRR) are limited, with potential for variation in clinical practice. This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding LRR management.

Methods
UK breast units were invited to take part in the MARECA study MDT NPQ. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy.

Results
822 MDT members across 42 breast units (out of 144; 29%) participated in the NPQ (February–August 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%).

For patients previously treated with breast conserving surgery (BCS) and radiotherapy, few units (7%) always/usually offered repeat BCS. However, in the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with isolated local recurrence following previous BCS and SLNB (sentinel lymph node biopsy), most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure.

For ER positive, HER2 negative, node negative local recurrence, 10% of units always/usually offered chemotherapy. For ER positive, HER2 negative, node positive local recurrence, this recommendation increased to 64%. For triple negative breast cancer local recurrence, 90% of units always/usually offered chemotherapy.

Conclusion
This survey has highlighted where consistencies and variations exist in the multidisciplinary management of breast cancer LRR. However, further research is required to determine how these management patterns influence patient outcomes, which will further refine optimal treatment pathways.
Breast cancer, Locoregional, Metastases, Recurrence
0748-7983
Morgan, J.
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Cheng, V.
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Barry, P.
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Copson, Ellen
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Cutress, Ramsey
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Dave, R
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Elsberger, B
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Fairbrother, P
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Hartup, S
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Hogan, B
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Horgan, K
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Kirwan, C C
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McIntosh, S A
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O'Connell, R L
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Patani, N
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Potter, S
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Rattay, T
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Sheehan, L
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Wyld, L
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Kim, B
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Morgan, J.
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Cheng, V.
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Barry, P.
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Copson, Ellen
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Cutress, Ramsey
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Dave, R
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Elsberger, B
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Fairbrother, P
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Hartup, S
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Hogan, B
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Horgan, K
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Kirwan, C C
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McIntosh, S A
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O'Connell, R L
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Patani, N
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Potter, S
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Rattay, T
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Sheehan, L
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Wyld, L
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Kim, B
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Morgan, J., Cheng, V., Barry, P., Copson, Ellen, Cutress, Ramsey, Dave, R, Elsberger, B, Fairbrother, P, Hartup, S, Hogan, B, Horgan, K, Kirwan, C C, McIntosh, S A, O'Connell, R L, Patani, N, Potter, S, Rattay, T, Sheehan, L, Wyld, L and Kim, B (2022) The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making. European Journal of Surgical Oncology.

Record type: Article

Abstract

Introduction
Evidence based guidelines for the optimal management of breast cancer locoregional recurrence (LRR) are limited, with potential for variation in clinical practice. This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding LRR management.

Methods
UK breast units were invited to take part in the MARECA study MDT NPQ. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy.

Results
822 MDT members across 42 breast units (out of 144; 29%) participated in the NPQ (February–August 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%).

For patients previously treated with breast conserving surgery (BCS) and radiotherapy, few units (7%) always/usually offered repeat BCS. However, in the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with isolated local recurrence following previous BCS and SLNB (sentinel lymph node biopsy), most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure.

For ER positive, HER2 negative, node negative local recurrence, 10% of units always/usually offered chemotherapy. For ER positive, HER2 negative, node positive local recurrence, this recommendation increased to 64%. For triple negative breast cancer local recurrence, 90% of units always/usually offered chemotherapy.

Conclusion
This survey has highlighted where consistencies and variations exist in the multidisciplinary management of breast cancer LRR. However, further research is required to determine how these management patterns influence patient outcomes, which will further refine optimal treatment pathways.

Text
MARECA NPQ revised manuscript for EJSO track changes 4th March 2022 - Accepted Manuscript
Restricted to Repository staff only until 25 March 2023.
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Text
1-s2.0-S0748798322001585-main (1) - Proof
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More information

Accepted/In Press date: 25 March 2022
Published date: 4 April 2022
Keywords: Breast cancer, Locoregional, Metastases, Recurrence

Identifiers

Local EPrints ID: 456700
URI: http://eprints.soton.ac.uk/id/eprint/456700
ISSN: 0748-7983
PURE UUID: f12b6e3f-af1b-49aa-ab57-ef38863ffb09

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Date deposited: 09 May 2022 17:16
Last modified: 08 Jun 2022 16:31

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Contributors

Author: J. Morgan
Author: V. Cheng
Author: P. Barry
Author: Ellen Copson
Author: Ramsey Cutress
Author: R Dave
Author: B Elsberger
Author: P Fairbrother
Author: S Hartup
Author: B Hogan
Author: K Horgan
Author: C C Kirwan
Author: S A McIntosh
Author: R L O'Connell
Author: N Patani
Author: S Potter
Author: T Rattay
Author: L Sheehan
Author: L Wyld
Author: B Kim

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