A REVIEW OF THE BURDENS AND OUTCOMES OF NEO-ADJUVANT CHEMOTHERAPY THE THE TREATMENT OF LOCALLY ADVANCED BREAST CANCERS AT THE CWMH FROM 2015-2017

Key Words: Locally Advanced breast cancer (LABC), Neo-adjuvant chemotherapy (NACT)
Introduction:
Breast cancer is the commonest cancer worldwide and also in Fiji. The majority of patients treated at the CWM hospital present with advanced disease. Since late 2014 neo-adjuvant chemotherapy had been introduced in the treatment of the locally advanced breast cancers at the CWM hospital to achieve better outcomes of treatment. There has not been an assessment of the outcomes since and it has not been the sole means of treatment of the locally advanced breast cancers locally.
Aim:
To define the demographics and workload of women with LABC at the CWMH from 2015-2017, the characteristics of breast cancer in the study population and assess the treatment outcomes of the NACT vs No NACT.
Method:
The study is a retrospective study of women diagnosed with LABC at the CWM hospital from 2015-2017.
The inclusion criteria was all women who had LABC who received a mastectomy with a curative intent. The women diagnosed with breast cancer were firstly identified using the laboratory information system (LIS) and records of all women who had a mastectomy during the study period. They were then divided into 2 groups-those that received NACT and those that did not. The 2 groupd were then analysed to look at the effectiveness of neoadjuvant chemotherapy in achieving better outcomes in the study cohort.
Results:
Only 40 % of women diagnosed with breast cancer underwent treatment with a curative intent. The demographics of the patients are similar to what is seen globally and the ethnic distribution reflects the local population. The number of mastectomies had increased over the 3 years of the study with 2016 having the peak number. The popularity of the NACT became more popular over the 3 years with an almost threefold increase in 2017 compared to 2015.
The characteristics of the breast tumors showed that not only do patients present late, but the majority of the patients have aggressive disease with the majority having intermediate-high grade tumors and the majority being estrogen receptor (ER)/ progesterone reeptor (PR) negative tumors.
The results of the NACT compared to not receiving NACT were similar across the board with the worst outcomes both surgically and in terms of a 1 year follow up were shown here.
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Discussion:
It is common in the study cohort for women to present with advanced stage of the disease as is seen in most developing countries. There is no ethnic predisposition seen in the study population. The biology of cancers seen here are aggressive types of cancer.