Key contact person/care coordinator (Recommendation)
A key contact person, ideally a breast care nurse and/or a cancer care coordinator, should be agreed as soon as possible to support communication and coordination of patient-centred care. If appropriate, consultations may be via telephone and/or video conferencing calls, especially in regional or remote areas.
How this guidance was developed
This recommendation was adapted from the KCE 2013 guideline (Belgium). The source recommendation is based on a systematic review of the evidence conducted to January 2010 and was graded ‘strong’ (using GRADE methods). The recommendation was expanded to cover all patients. In addition, no evidence-based source recommendation was identified for the care of patients in regional and remote areas, which was considered an important aspect of care in Australia. This additional element of the adapted recommendation was developed using an expert consensus process.
MDT treatment planning - General (Practice Point)
Discuss all cases of breast cancer within a multidisciplinary team (MDT) treatment planning meeting at least once, and ideally before any treatment, including surgery, is initiated so that a treatment plan can be recommended that takes account of patient comorbidities and includes consideration for neoadjuvant systemic therapy. If possible, results of all relevant tests and imaging should be available for the MDT discussion. Consider a follow-up discussion if there is significant change in the course of the disease after commencement of therapy.
How this guidance was developed
No evidence-based source recommendation was identified for this topic, which was considered an important aspect of care. The practice point was developed using an expert consensus process. The practice was informed by a source recommendation in the KCE 2013 guidelines (Belgium) that was designated as ‘Expert Opinion’.
MDT treatment planning - Pregnant women (Practice Point)
Include obstetricians and perinatologists in the multidisciplinary team (MDT) for the treatment of patients with breast cancer during pregnancy. Particular attention should be paid to each woman’s preferences and psychosocial needs due to the higher likelihood of distress.
How this guidance was developed
No evidence-based source recommendation was identified for this topic, which was considered an important aspect of care. This practice point was developed using an expert consensus process. The practice point was informed by a source recommendation in the ESO-ESMO 2017 guidelines for breast cancer in young women (Europe) that was designated ‘Expert Opinion’ by the source guideline authors.
MDT treatment planning - Cardiac care
Close and early collaboration between oncologists and cardiologists is recommended for those patients that require treatment with a potentially cardiotoxic treatment, particularly in the context of existing cardiovascular disease or multiple cardiovascular risk factors.
How this guidance was developed
No evidence-based source recommendation for this aspect of care was identified in early breast cancer specifically, however the inclusion of cardiac care was considered to be important for this guidance. This practice point was subsequently informed by a recommendation from the ESMO 2020 guidelines (Europe) on the management of cardiac disease throughout oncological treatment. The ESMO recommendation was based on a systematic review of the evidence to June 2018 and was graded ‘A’ using ESMO methods (i.e. according to the ESMO adapted Infectious Diseases Society of America-United States Public Health Service Grading System) by the source guideline authors.
Treatment planning considerations - Older patients
Generally, age alone should not dictate treatment decisions, however all management decisions for an older patient should consider life expectancy; potential risks versus absolute benefits; treatment tolerance; patient preferences; potential barriers to treatment; polypharmacy; and assessment of functional status, comorbidities, falls, depression, cognition, nutritional status and social situation.
How this guidance was developed
This recommendation was adapted from the SIOG/EUSOMA 2012 guideline (Europe) for the management of older patients with breast cancer. Two source recommendations from the same guideline were merged and adapted by simplifying the recommendations and adding 'age alone should not dictate treatment decisions' (which is included in the narrative of the guidelines publication). Both source recommendations were based on a systematic review of the evidence conducted to June 2010 and were not graded by the source guideline authors.
