ArticleAnnals of surgical oncology2021
Trends in Breast Cancer Treatment De-Implementation in Older Patients with Hormone Receptor-Positive Breast Cancer: A Mixed Methods Study.
Article in Annals of surgical oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- De-implementing low-value care in cancer care delivery: a systematic review.Implementation science : IS · 2022Pooled it
- Understanding the patient journey: Barriers, facilitators, and expectations in joining a chemotherapy de-escalation trial among premenopausal patients with breast cancer.Breast (Edinburgh, Scotland) · 2026Article
- Omission of Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer: Expanding Evidence in Clinically Node-Negative and Neoadjuvant Therapy Responders.World journal of oncology · 2026Review
- De-Escalation of Axillary Surgery: A Review of Choosing Wisely Guideline Evidence.World journal of oncology · 2026Review
- Sentinel Lymph Node Biopsy in Low-Risk Breast Cancer in Patients ≥ 70 Years: How Wisely are We Choosing?Annals of surgical oncology · 2026Article
- Multi-level factors drive use of sentinel lymph node biopsy in older women with early-stage breast cancer.Breast cancer research and treatment · 2025Article
- Management of the Axilla in Older Patients with Breast Cancer: Reassessing the Role of Sentinel Lymph Node Biopsy.Cancers · 2025Article
- Patient and Family Caregiver Perspectives on Therapy De-Escalation in Cancer: A Scoping Review.Psycho-oncology · 2025Article
- Factors associated with patients' demand for low-value care: a scoping review.BMC health services research · 2024Article
- Behavioral Interventions on Surgeons' Preoperative Decision-Making: A Scoping Review and Critical Analysis.The Journal of surgical research · 2024Article
- How to Optimize Deimplementation of Sentinel Lymph Node Biopsy?The breast journal · 2024Article
- De-Implementation of Low-Value Care for Women 70 Years of Age or Older with Low-Risk Breast Cancer During the COVID-19 Pandemic.Annals of surgical oncology · 2023Article
- De-implementation of Low-Value Practices for Autism Spectrum Disorder.Clinical child and family psychology review · 2023Review
- De-Implementation of Axillary Staging and Radiotherapy in Low-Risk Breast Cancer Patients Aged 70-79 Years from Six Italian Cancer Institutes.Current oncology (Toronto, Ont.) · 2023Article
- Review of Cancer-Specific Quality Measures Promoting the Avoidance of Low-Value Care.Annals of surgical oncology · 2022Article
- Facility-Level Variation of Low-Value Breast Cancer Treatments in Older Women with Early-Stage Breast Cancer: Analysis of a Statewide Claims Registry.Annals of surgical oncology · 2022Article
- Peace of Mind: A Role in Unnecessary Care?Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2022Article
- Using Tailored Messages to Target Overuse of Low-Value Breast Cancer Care in Older Women.The Journal of surgical research · 2022Article
- Sentinel Node Biopsy Should Not be Routine in Older Patients with ER-Positive HER2-Negative Breast Cancer Who Are Willing and Able to Take Hormone Therapy.Annals of surgical oncology · 2021Article
- The Effect of Surgeon Referral and a Radiation Oncologist Productivity-Based Metric on Radiation Therapy Receipt Among Elderly Women With Early Stage Breast Cancer: Analysis From a Tertiary Cancer Network.Advances in radiation oncologyArticle
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
introductionGuidelines allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women ≥ 70 years of age with hormone receptor-positive (HR +) breast cancer. Despite this, national data suggest these procedures have not been widely de-implemented.
objectivesOur objectives were to evaluate trends in SLNB and post-lumpectomy radiotherapy utilization in patients who are eligible for omission, and evaluate patient preferences as a target for de-implementation of low-value care.
methodsWe performed a sequential explanatory mixed-methods study by first analyzing an institutional database of patients ≥ 70 years of age with HR + breast cancer who received surgical treatment from 2014 to 2018. Based on the quantitative data, we conducted semi-structured interviews with women identified as high or low utilizers of breast cancer treatments to elicit patient perspectives on de-implementation.
resultsSLNB and post-lumpectomy radiotherapy were performed in 68% and 43% of patients, respectively, who met the criteria for omission. There was a significant decrease in SLNB rates from 2014 to 2018. Forty-nine percent of patients were classified as high utilizers and 26% were classified as low utilizers. Qualitative analysis found that the most important factors influencing decision making regarding SLNB and post-lumpectomy radiotherapy omission for both high and low utilizers were trust in their provider and a desire for peace of mind.
conclusionsDespite efforts to de-implement low-value care, older women with HR + breast cancer remain at risk of overtreatment. Patient perspectives suggest that multi-level de-implementation strategies will need to target provider practice patterns and patient-provider communication to promote high-quality decision making and reduction in breast cancer overtreatment.
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Registered trials
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