Practitioner Feedback
Practitioner feedback was obtained through a mailed survey of 109 practitioners in Ontario (77 medical oncologists and 32 radiation and/or surgical oncologists). The survey consisted of items evaluating the methods, results, and interpretive summary used to inform the draft recommendations and whether the draft recommendations above should be approved as a practice guideline. Written comments were invited. The practitioner feedback survey was mailed out on June 21, 2005. Follow-up reminders were sent at two weeks (post card) and four weeks (complete package mailed again). The Breast Cancer Disease Site Group (DSG) reviewed the results of the survey.
Review by Report Approval Panel
Overall, the Panel agreed this was comprehensive document that covered complex literature. Two key issues were identified by both reviewers:
- Given the range of treatment options identified, the reviewers felt that it would be helpful if the group could put the recommended options in context, for example, through use of an algorithm or examination of trade-offs between recommended treatments. However, the reviewers also acknowledged that evidence to provide such context may not be available.
- The reviewers suggested that the group consider conducting broader meta-analyses (e.g., class-specific comparisons or meta-analyses to explore potential sub-group effects).
With regard to the suggestion about meta-analyses, the Breast Cancer DSG felt that, at this time, a broader analysis would not provide significant new information with which to make broader recommendations.
Final Review by the Breast Cancer DSG
During the final review process by the Breast Cancer DSG, several members raised concerns similar to those raised by the Report Approval Panel (RAP) regarding the array of treatment options. These members felt strongly that some overall statement regarding adjuvant chemotherapy was necessary to make the recommendations useful to clinicians.
Response to Review by the Breast Cancer DSG and the Report Approval Panel
In response to this feedback from the Breast Cancer DSG and the Report Approval Panel, a summary recommendation was added that presented overall guidance regarding taxanes in adjuvant chemotherapy. A new meta-analysis was not conducted, as the authors felt that it would not provide sufficient additional evidence to warrant new recommendations. The Breast Cancer DSG also recognized the need for a future practice guideline that would combine all the current recommendations for adjuvant systemic therapy and provide guidance to clinicians in selecting appropriate regimens.