@article{TEXTUAL,
      recid = {11203},
      author = {Minami, Christina A. and Bryan, Ava F. and Freedman,  Rachel A. and Revette, Anna C. and Schonberg, Mara A. and  King, Tari A. and Mittendorf, Elizabeth A.},
      title = {Assessment of Oncologists' Perspectives on Omission of  Sentinel Lymph Node Biopsy in Women 70 Years and Older with  Early-Stage Hormone Receptor-Positive Breast Cancer},
      journal = {JAMA Network Open},
      address = {2022-08-24},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Importance: Randomized clinical trial data have  demonstrated that omission of surgical axillary evaluation  does not affect overall survival in women 70 years and  older with early-stage (clinical tumor category 1 [cT1]  with node-negative [N0] disease) hormone receptor  (HR)-positive and erb-B2 receptor tyrosine kinase 2 (ERBB2;  formerly HER2)-negative breast cancer. Therefore, the  Choosing Wisely initiative has recommended against routine  use of sentinel lymph node biopsy (SLNB) in this  population; however, retrospective data have revealed that  more than 80% of patients eligible for SLNB omission still  undergo the procedure. Multidisciplinary factors involved  in these patterns remain unclear.&lt;/p&gt;&lt;p&gt;Objective: To  describe surgical, medical, and radiation oncologists'  perspectives on omission of SLNB in women 70 years and  older with cT1N0 HR-positive, ERBB2-negative breast  cancer.&lt;/p&gt;&lt;p&gt;Design, Setting, and Participants: This  qualitative study used in-depth semi-structured interviews  to explore the factors involved in oncologists'  perspectives on providing care to older women who were  eligible for SLNB omission. Purposive snowball sampling was  used to recruit a sample of surgical, medical, and  radiation oncologists representing a wide range of practice  types and number of years in practice in the US and Canada.  A total of 29 oncologists who finished training and were  actively treating patients with breast cancer were  interviewed. Interviews were conducted between March 1,  2020, and January 17, 2021.&lt;/p&gt;&lt;p&gt;Main Outcomes and  Measures: Recordings from semi-structured interviews were  transcribed and deidentified. Thematic analysis was used to  identify emergent themes.&lt;/p&gt;&lt;p&gt;Results: Among 29  physicians (16 women [55.2%] and 13 men [44.8%]) who  participated in interviews, 16 were surgical oncologists, 6  were medical oncologists, and 7 were radiation oncologists.  Data on race and ethnicity were not collected. Participants  had a range of experience (median [range] years in  practice, 12.0 [0.5-30.0]) and practice types (14 academic  [48.3%], 7 community [24.1%], and 8 hybrid [27.6%]).  Interviews revealed that the decision to omit SLNB was  based on nuanced patient- and disease-level factors. Wide  variation was observed in oncologists' perspectives on SLNB  omission recommendations and supporting data. In addition,  participants' statements suggested that the  multidisciplinary nature of cancer care may increase  oncologists' anxiety regarding SLNB  omission.&lt;/p&gt;&lt;p&gt;Conclusions and Relevance: In this study,  findings from interviews revealed that oncologists'  perspectives may have implications for the largely  unsuccessful deimplementation of SLNB in women 70 years and  older with cT1N0 HR-positive, ERBB2-negative breast cancer.  Interventions aimed at educating physicians, improving  patient-physician communication, and facilitating  preoperative multidisciplinary conversations may help to  successfully decrease SLNB rates in this patient  population.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/11203},
}