Evaluation of the DCIS Score for Decisions on Radiotherapy in Patients With Low/Intermediate Risk DCIS

Ontario Clinical Oncology Group (OCOG)281 enrolled

Overview

To evaluate whether the use of the Oncotype DX DCIS score can guide delivery of radiation in women with low to moderate risk DCIS who have had breast conserving surgery

A prospective cohort study, conducted in Canada, to evaluate whether the use of the DCIS score changes the treatment recommended and the treatment received in women with low to moderate risk DCIS following breast conserving surgery who are candidates for radiation therapy. We plan to study 280 eligible, consenting women who will have their tumour tissue specimen sent to Genomic Health to assess their DCIS score. At each centre, all patients with DCIS referred to radiation oncology will be documented. When a physician identifies an eligible patient, the patient will be approached by the referring physician or delegate to voluntarily provide informed consent to participate in this study. Consenting patients will be registered through the Ontario Clinical Oncology Group's (OCOG) web-based registration system. Data related to the patient demographics, surgery details, and tumour characteristics will be collected. The preliminary treatment recommendation and patient preference for treatment will be documented. Patient Decisional Conflict will be documented by the patient using the Decisional Conflict Scale (DCS). The patient's tumour specimen will be sent for analysis to Genomic Health. DCIS score results will be sent to the referring physician. OCOG will also receive the DCIS score results. The final treatment recommendation, patient preference, and treatment received by the patient will be documented. Patient decisional conflict will be documented by the patient using the DCS. The study data will be verified by source documentation.

Study Type

OBSERVATIONAL

Enrollment

281

Conditions

DCIS

Eligibility

Sex: FEMALEMin age: 46 Years

Medical Language ↔ Plain English

Inclusion Criteria: (1) Women with newly diagnosed breast cancer treated by definitive surgery with histological evidence limited to DCIS. Exclusion Criteria: 1. Age \< or = 45; 2. Treated by mastectomy; 3. Surgical margins of \<1mm;(re-excisions may be performed where results are regarded as clear margins, these cases will not exclude patients); 4. Tumour size \>2.5cm; 5. Any invasive breast cancer including micro invasion; 6. Histological evidence of multifocality (defined as having more than one distinct focus of DCIS with \>5mm of intervening benign breast tissue in one quadrant of the breast); 7. Any associated lobular carcinoma in situ; 8. Previous diagnosis of ipsilateral invasive carcinoma or DCIS of the breast; 9. Any contraindication for whole breast irradiation such as chronic heart or lung disease or previous ipsilateral chest wall radiotherapy; 10. Physician/patient unwilling to comply with study protocol; and 11. Inability to provide informed consent (e.g. dementia or severe cognitive impairment).

Locations (12)

Tom Baker Cancer Centre

Calgary, Alberta, Canada

Cross Cancer Institute

Edmonton, Alberta, Canada

BC Cancer Agency - Vancouver Island

Victoria, British Columbia, Canada

Outcomes

Primary Outcomes

Change in radiotherapy treatment recommendation made by physician

The primary outcome is change in treatment recommendation by the radiation oncologist. Physicians will be asked to indicate their preliminary treatment recommendation at the first visit based on clinical factors alone. They will be asked to describe course of radiation including dose and number of fractions. They will then be asked to make a final treatment recommendation when the DCIS score is available. If the physician final recommendation is not consistent with the DCIS score predicted treatment, they will be asked to indicate reasons for their recommendation. If radiation is recommended, they will be asked to indicate the treatment prescription including dose and number of fractions. The actual treatment received by the patient will also be collected.

Time frame: 2.5 years

Secondary Outcomes

Change in radiotherapy treatment preference by patient

Secondary outcomes will include change in treatment preference by the patient for radiotherapy and change in recommendations by the physician for hormonal therapy or further surgery. It will also compare physician's prediction of LR with or without radiation that is estimated by the DCIS score. Finally, change in level of patient decisional conflict as measured by DCS will also be collected. The DCS was developed and used to evaluate the effect of decision aids on decision making by health consumers.The assumption was that decision aids would reduce the uncertainty and confusion in choosing a course of action. Decisional conflict is a state of uncertainty about the course of action to take.

Time frame: 2.5 years

Data from ClinicalTrials.gov

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