BPI21-003: Analysis of NAPBC Accreditation Data From a Multi-Disciplinary Accredited Unit in JHB SA Shows That Tumour Biology Not Stage Dictates Treatment Choice With an Increasing Use of Neo-Adjuvant Chemotherapy (NACT)

Authors: Carol-Ann Benn MBBCh1,2,3, Bernardo Rapoport Dip in Med1,4,5, Yastira Ramdas MBChB, DCH, Fc Rad Onc, Mmed1, Barend van den Bergh MBChB, FC PLAST SURG1, Dominic van Loggerenberg1, and Vernon Shaw1
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  • 1 Netcare Milpark Hospital, Johannesburg, Gauteng, South Africa
  • | 2 Helen Joseph Hospital, Johannesburg, South Africa
  • | 3 University of the Witwatersrand, Johannesburg, South Africa
  • | 4 University of Pretoria, Pretoria, South Africa
  • | 5 The Medical Oncology Centre of Rosebank, Johannesburg, South Africa

Introduction: The Netcare Breast Care Centre of Excellence in Johannesburg, South Africa received its first NAPBC accreditation in November 2016 and its full reaccreditation in November 2019. Seeing more than 500 newly diagnosed cancers per year, the centre implements international best practice guidelines and is at the forefront of innovation in breast cancer patient care. Headed by Professor Carol Benn, the centre is comprised of a multidisciplinary team that includes specialist surgeons, oncoplastic and reconstructive surgeons, medical oncologists, radiation oncologists, diagnostic radiologists, pathologists, genetic counselors, occupational therapists, oncology navigators and complementary navigators. Materials and Methods: This analysis used the accreditation-related data that is continually updated to monitor clinical practice and patient outcomes in the interest of maintaining quality patient care. A general biographical filter and analysis were used that provided the total number of newly diagnosed patients that were seen each year, the range of ages at diagnosis and the average. A breakdown was formed per clinical stage at diagnosis (before treatment began); and subsequently grouped into early and late-stage disease. A parallel population analysis was conducted to match different stages of the disease to the rate at which patients received (NACT) intending to form a cross-impact analysis. Results: This analysis found that the number of newly diagnosed patients treated at the centre averaged at 550 patients, ranging from 431 to 669. Of these, the median age at diagnosis was 55.9 with a range of 24 to 93 years of age. Across the time frame late-stage disease only encompassed 10.6% of patients. Approximately 46.0% of all patients that underwent oncological treatment received NACT, comprising 32.2% of the total patient population. Conclusion: The comparatively high rate of NACT given compared to the proportion of patients that present with late-stage disease is emblematic of adoption of current data and recommendations on the treatment of breast cancer, whereby NACT can infer a therapeutic benefit to patients that also fall within the early-stage disease bracket, not just those presenting with late-stage disease. A treatment trend based cancer biology as opposed to stage and size is evident. The blanket guideline of late-stage NACT and early-stage surgery is being replaced with an analysis of the biology and appropriate first-line treatment.

Corresponding Author: Carol-Ann Benn, MBBCh
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