Columbia University Medical Center

Compliance with Chemotherapy Varies with Strength of Physician’s Recommendation


As part of their Breast Cancer Quality of Care (BQUAL) study, a research team led by Alfred I. Neugut, MD, PhD, and Dawn L. Hershman, MD, MS, interviewed 1,150 women who were diagnosed with nonmetastatic breast cancer between 2006 and 2010. The goal was to determine the extent of and reasons for noncompliance with chemotherapy. The encouraging finding was that the women for whom chemotherapy was most critical were most likely to begin treatment.

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Using the guidelines for breast cancer treatment of the National Comprehensive Cancer Network, the researchers grouped the women into four categories: those for whom chemotherapy was definitely indicated, those for whom chemotherapy was optional, those over age 70 (for whom chemotherapy is always optional), and those for whom chemotherapy was definitely not indicated.

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Of the women for whom chemotherapy was definitely recommended, 90 percent began treatment. Of those for whom chemotherapy was optional because of clinical criteria, 36 percent began treatment, and of those for whom chemotherapy was optional because of age, 19 percent began treatment.

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The researchers also found that those who were younger and believed more strongly in the efficacy of treatment were more likely to undergo chemotherapy, as were those who were less worried about the expected side effects, particularly nausea.

“Noninitiation of Adjuvant Chemotherapy in Women With Localized Breast Cancer: The Breast Cancer Quality of Care Study” was published online in the Journal of Clinical Oncology on September 24, 2012.

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