Top

Published in:

Open Access 01-12-2021 | Prostate Cancer | Research article

Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists

Authors: Shellie D. Ellis, Soohyun Hwang, Emily Morrow, Kim S. Kimminau, Kelly Goonan, Laurie Petty, Edward Ellerbeck, J. Brantley Thrasher

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

Clinical practice guidelines recommend active surveillance as the preferred treatment option for low-risk prostate cancer, but only a minority of eligible men receive active surveillance, and practice variation is substantial. The aim of this study is to describe barriers to urologists’ recommendation of active surveillance in low-risk prostate cancer and explore variation of barriers by setting.

Methods

We conducted semi-structured interviews among 22 practicing urologists, evenly distributed between academic and community practice. We coded barriers to active surveillance according to a conceptual model of determinants of treatment quality to identify potential opportunities for intervention.

Results

Community and academic urologists were generally in agreement on factors influencing active surveillance. Urologists perceived patient-level factors to have the greatest influence on recommendations, particularly tumor pathology, patient age, and judgements about the patient’s ability to adhere to follow-up protocols. They also noted cross-cutting clinical barriers, including concerns about the adequacy of biopsy samples, inconsistent protocols to guide active surveillance, and side effects of biopsy procedures. Urologists had differing opinions on the impact of environmental factors, such as financial disincentives and fear of litigation.

Conclusions

Despite national and international recommendations, both academic and community urologists note a variety of barriers to implementing active surveillance in low risk prostate cancer. These barriers will need to be specifically addressed in efforts to help urologists offer active surveillance more consistently.

Network NCC. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™). In: Practice Guidelines in Oncology. Fort Washington: National Comprehensive Cancer Network, 2010. v.3; 2010.

Bahnson RR, Hanks GE, Huben RP, Kantoff P, Kozlowski JM, Kuettel M, et al. nccn practice guidelines for prostate cancer. Oncology (Williston Park). 2000;14(11A):111–9.

Network NCC. Prostate cancer. In: NCCN practice guidelines in oncology. Fort Washington: National Comprehensive Cancer Network, v.1.2004 edn; 2004.

Ganz P, Barry J, Burke W, Col N, Corso P, Dodson E, et al. National Institutes of Health state-of-the-science conference statement: role of active surveillance in the management of men with localized prostate cancer. NIH Consens State Sci Statements. 2011;28(1):1–27.PubMed

Yamamoto T, Musunuru B, Vesprini D, Zhang L, Ghanem G, Loblaw A, et al. Metastatic prostate cancer in men initially managed with active surveillance. J Urol. 2015;193(4S). https://doi.org/10.1016/j.juro.2015.02.149.

Tosoian JJ, Mamawala M, Epstein JI, Landis P, Wolf S, Trock BJ, et al. Intermediate and longer-term outcomes from a prospective active-surveillance program for favorable-risk prostate cancer. J Clin Oncol. 2015;33(30):3379–85. https://doi.org/10.1200/JCO.2015.62.5764.CrossRefPubMedPubMedCentral

Cooperberg MR, Carroll PR. Treatment trends for prostate Cancer--reply. JAMA. 2015;314(18):1977–8. https://doi.org/10.1001/jama.2015.12607.CrossRefPubMed

Chen RC, Rumble RB, Loblaw DA, et al. Active Surveillance for the Management of Localized Prostate Cancer (Cancer Care Ontario Guideline): American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol. 2016;34(18):2182-90. https://doi.org/10.1200/JCO.2015.65.7759.

Hall IJ, Richardson LC. Commentary on the state-of-the-science conference on the role of active surveillance in the management of men with localized prostate cancer. J Natl Cancer Inst Monogr. 2012;2012(45):135–9. https://doi.org/10.1093/jncimonographs/lgs040.CrossRefPubMedPubMedCentral

10.

Chamie K, Williams SB, Hu JC. Population-based assessment of determining treatments for prostate cancer. JAMA Oncol. 2015;1(1):60–7. https://doi.org/10.1001/jamaoncol.2014.192.CrossRefPubMed

11.

Chamie K, Williams SB, Hershman DL, Wright JD, Nguyen PL, Hu JC. Population-based assessment of determining predictors for quality of prostate cancer surveillance. Cancer. 2015;121(23):4150–7.CrossRef

12.

Cooperberg MR, Carroll PR. Trends in Management for Patients with Localized Prostate Cancer, 1990-2013. JAMA. 2015;314(1):80–2. https://doi.org/10.1001/jama.2015.6036.CrossRefPubMed

13.

Barocas DA, Cowan JE, Smith JA Jr, Carroll PR, Ca PI. What percentage of patients with newly diagnosed carcinoma of the prostate are candidates for surveillance? An analysis of the CaPSURE database. J Urol. 2008;180(4):1330–4; discussion 1334-1335. https://doi.org/10.1016/j.juro.2008.06.019.CrossRefPubMed

14.

Womble PR, Montie JE, Ye Z, Linsell SM, Lane BR, Miller DC. Michigan urological surgery improvement C: contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer. Eur Urol. 2015;67(1):44–50. https://doi.org/10.1016/j.eururo.2014.08.024.CrossRefPubMed

15.

Scherr KA, Fagerlin A, Hofer T, et al. Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions. Med Decis Making. 2017;37(1):56-69. https://doi.org/10.1177/0272989X16662841.

16.

Reamer E, Yang F, Holmes-Rovner M, Liu J, Xu J. Influence of Men's personality and social support on treatment decision-making for localized prostate cancer. Biomed Res Int. 2017;2017:1467056.CrossRef

17.

Holmes-Rovner M, Srikanth A, Henry SG, Langford A, Rovner DR, Fagerlin A. Decision aid use during post-biopsy consultations for localized prostate cancer. Health Expect. 2018;21:279–87. https://doi-org.libproxy.lib.unc.edu/10.1111/hex.12613.

18.

Holmes-Rovner M, Montgomery JS, Rovner DR, Scherer LD, Whitfield J, Kahn VC, et al. Informed decision making: assessment of the quality of physician communication about prostate Cancer diagnosis and treatment. Med Decis Making. 2015;35(8):999–1009. https://doi.org/10.1177/0272989X15597226.CrossRefPubMed

19.

Adsul P, Wray R, Spradling K, Darwish O, Weaver N, Siddiqui S. Systematic review of decision Aids for newly diagnosed patients with prostate cancer making treatment decisions. J Urol. 2015;194(5):1247–52. https://doi.org/10.1016/j.juro.2015.05.093.CrossRefPubMed

20.

Scherr KA, Fagerlin A, Hofer T, Scherer LD, Holmes-Rovner M, Williamson LD, et al. Physician recommendations trump patient preferences in prostate cancer treatment decisions. Med Decis Making. 2017;37(1):56–69. https://doi.org/10.1177/0272989X16662841.CrossRefPubMed

21.

Showalter TN, Mishra MV, Bridges JF. Factors that influence patient preferences for prostate cancer management options: a systematic review. Patient Prefer Adherence. 2015;9:899–911. https://doi.org/10.2147/PPA.S83333.CrossRefPubMedPubMedCentral

22.

Donovan JL. Presenting treatment options to men with clinically localized prostate cancer: the acceptability of active surveillance/monitoring. J Natl Cancer Inst Monogr. 2012;2012(45):191–6. https://doi.org/10.1093/jncimonographs/lgs030.CrossRefPubMedPubMedCentral

23.

Sidana A, Hernandez DJ, Feng Z, Partin AW, Trock BJ, Saha S, et al. Treatment decision-making for localized prostate cancer: what younger men choose and why. Prostate. 2012;72(1):58–64. https://doi.org/10.1002/pros.21406.CrossRefPubMed

24.

Xu J, Neale AV, Dailey RK, Eggly S, Schwartz KL. Patient perspective on watchful waiting/active surveillance for localized prostate cancer. J Am Board Fam Med. 2012;25(6):763–70. https://doi.org/10.3122/jabfm.2012.06.120128.CrossRefPubMedPubMedCentral

25.

Zeliadt SB, Moinpour CM, Blough DK, Penson DF, Hall IJ, Smith JL, et al. Preliminary treatment considerations among men with newly diagnosed prostate cancer. Am J Manag Care. 2010;16(5):e121–30.PubMed

26.

Shahinian VB, Kuo YF, Freeman JL, Orihuela E, Goodwin JS. Characteristics of urologists predict the use of androgen deprivation therapy for prostate cancer. J Clin Oncol. 2007;25(34):5359–65. https://doi.org/10.1200/JCO.2006.09.9580.CrossRefPubMedPubMedCentral

27.

Loeb S, Curnyn C, Fagerlin A, Braithwaite RS, Schwartz MD, Lepor H, et al. Qualitative study on decision-making by prostate cancer physicians during active surveillance. BJU Int. 2017;120(1):32–9. https://doi.org/10.1111/bju.13651.CrossRefPubMed

28.

Spencer BA, Miller DC, Litwin MS, Ritchey JD, Stewart AK, Dunn RL, et al. Variations in quality of care for men with early-stage prostate cancer. J Clin Oncol. 2008;26(22):3735–42. https://doi.org/10.1200/JCO.2007.13.2555.CrossRefPubMed

29.

Ellis SD, Nielsen ME, Carpenter WR, Jackson GL, Wheeler SB, Liu H, et al. Gonadotropin-releasing hormone agonist overuse: urologists' response to reimbursement and characteristics associated with persistent overuse. Prostate Cancer Prostatic Dis. 2015;18(2):173–81. https://doi.org/10.1038/pcan.2015.10.CrossRefPubMedPubMedCentral

30.

Cooperberg MR, Broering JM, Carroll PR. Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol. 2010;28(7):1117–23. https://doi.org/10.1200/JCO.2009.26.0133.CrossRefPubMedPubMedCentral

31.

Luckenbaugh AN, Auffenberg GB, Hawken SR, Dhir A, Linsell S, Kaul S, et al. Michigan urological surgery improvement C: variation in guideline concordant active surveillance follow-up in diverse urology practices. J Urol. 2016;195(4S). https://doi.org/10.1016/j.juro.2016.02.2528.

32.

Ellis SD, Chen RC, Dusetzina SB, Wheeler SB, Jackson GL, Nielsen ME, et al. Are small reimbursement changes enough to change cancer care? reimbursement variation in prostate cancer treatment. J Oncol Pract. 2016;12(4):e423–36. https://doi.org/10.1200/JOP.2015.007344.CrossRefPubMedPubMedCentral

33.

Frolich A, Talavera JA, Broadhead P, Dudley RA. A behavioral model of clinician responses to incentives to improve quality. Health Policy. 2007;80(1):179–93. https://doi.org/10.1016/j.healthpol.2006.03.001.CrossRefPubMed

34.

Feldstein PJ. Health policy issues: an economic perspective. 4th ed. Chicago: Health Administration Press; 2007.

35.

Rice TH. The impact of changing medicare reimbursement rates on physician-induced demand. Med Care. 1983;21(8):803–15. https://doi.org/10.1097/00005650-198308000-00004.CrossRefPubMed

36.

Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208–20.PubMedPubMedCentral

37.

Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1–10. https://doi.org/10.2307/2137284.CrossRefPubMed

38.

Golden BR, Sloan FA. Physician pay for performance: alternative perspectives. In: Sloan FA, Kasper H, editors. Incentives and Choice in Health Care. Cambridge: The MIT Press; 2008.

39.

Strand H, Parker D. Effects of multidisciplinary models of care for adult pre-dialysis patients with chronic kidney disease: a systematic review. Int J Evid Based Healthc. 2012;10(1):53–9. https://doi.org/10.1111/j.1744-1609.2012.00253.x.CrossRefPubMed

40.

Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM. The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med. 2010;170(4):369–76. https://doi.org/10.1001/archinternmed.2009.521.CrossRefPubMedPubMedCentral

41.

Fleissig A, Jenkins V, Catt S, Fallowfield L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol. 2006;7(11):935–43. https://doi.org/10.1016/S1470-2045(06)70940-8.CrossRefPubMed

42.

Spradley J. The ethnographic interview Fort Worth: Harcourt. Janovich: Brace; 1979.

43.

Brooks JV, Ellis SD, Morrow E, Kimminau KS, Thrasher JB. Patient factors that influence how physicians discuss active surveillance with low-risk prostate cancer patients: a qualitative study. Am J Mens Health. 2018;12(5):1719–27. https://doi.org/10.1177/1557988318785741.CrossRefPubMedPubMedCentral

44.

Ellis SD, Bertoni AG, Bonds DE, Clinch CR, Balasubramanyam A, Blackwell C, et al. Value of recruitment strategies used in a primary care practice-based trial. Contemp Clin Trials. 2007;28(3):258–67. https://doi.org/10.1016/j.cct.2006.08.009.CrossRefPubMed

45.

Valente TW, Davis RL. Accelerating the diffusion of innovations using opinion leaders. Ann Am Acad Polit Ss. 1999;566(1):55–67. https://doi.org/10.1177/000271629956600105.CrossRef

46.

Scientific Software: atlas.ti: the knowledge workbench. Ver 6.2. ATLAS.ti Scientific Software Development GmbH. 2011.

47.

Symon G, Cassell C. Qualitative methods and analysis in organizational research: a practical guide. 12th ed. Thousand Oaks: Sage Publications Ltd; 1998.

48.

Creswell JW. Qualitative inquiry and research design: choosing among five traditions. Thousand Oaks: Sage Publications; 1998.

49.

Creswell JW. Research design: qualitative, quantitative and mixed methods approaches 4th Ed. Los Angeles: SAGE Publications; 2014.

50.

Kim SP, Gross CP, Nguyen PL, Smaldone MC, Shah ND, Karnes RJ, et al. Perceptions of active surveillance and treatment recommendations for low-risk prostate Cancer: results from a National Survey of radiation oncologists and urologists. Med Care. 2014;52(7):579–85. https://doi.org/10.1097/MLR.0000000000000155.CrossRefPubMed

51.

National Comprehensive Cancer Network. Prostate Cancer. In: NCC N, editor. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines); 2016. Version 3.2016 edn; 2016.

52.

Roth JA, Ramsey SD, Carlson JJ. Cost-effectiveness of a biopsy-based 8-protein prostate cancer prognostic assay to optimize treatment decision making in Gleason 3 + 3 and 3 + 4 early stage prostate cancer. Oncologist. 2015;20(12):1355–64. https://doi.org/10.1634/theoncologist.2015-0214.CrossRefPubMedPubMedCentral

53.

Pang K, Fitch M, Ouellet V, Chevalier S, Drachenberg DE, Finelli A, et al. Describing perspectives of health care professionals on active surveillance for the management of prostate cancer. BMC Health Serv Res. 2018;18(1):430. https://doi.org/10.1186/s12913-018-3273-9.CrossRefPubMedPubMedCentral

54.

Klotz L, Vesprini D, Sethukavalan P, Jethava V, Zhang L, Jain S, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. J Clin Oncol. 2015;33(3):272–7. https://doi.org/10.1200/JCO.2014.55.1192.CrossRefPubMed

55.

Cher ML, Dhir A, Auffenberg GB, Linsell S, Gao Y, Rosenberg B, et al. Appropriateness criteria for active surveillance of prostate cancer. J Urol. 2016;195(4S). https://doi.org/10.1016/j.juro.2016.02.2527.

56.

Cooperberg MR. Long-term active surveillance for prostate cancer: answers and questions. J Clin Oncol. 2015;33(3):238–40. https://doi.org/10.1200/JCO.2014.59.2329.CrossRefPubMed

57.

Schenk JM, Newcomb LF, Zheng Y, Faino AV, Zhu K, Nyame YA, et al. African American race is not associated with risk of reclassification during active surveillance: results from the canary prostate cancer active surveillance study. J Urol. 2020;203(4):727–33. https://doi.org/10.1097/JU.0000000000000621.CrossRefPubMed

58.

Association AU. Prostate Cancer. In: Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline (2017): Association AU; 2017.

59.

Gettman MT. Better understanding of minimizing infectious complications after transrectal prostate biopsy. Eur Urol. 2012;62(3):460–1. https://doi.org/10.1016/j.eururo.2012.05.037.CrossRefPubMed

60.

Loeb S, Vellekoop A, Ahmed HU, Catto J, Emberton M, Nam R, et al. Systematic review of complications of prostate biopsy. Eur Urol. 2013;64(6):876–92. https://doi.org/10.1016/j.eururo.2013.05.049.CrossRefPubMed

61.

Murray KS, Bailey J, Zuk K, Lopez-Corona E, Thrasher JB. A prospective study of erectile function after transrectal ultrasonography-guided prostate biopsy. BJU Int. 2015;116(2):190–5. https://doi.org/10.1111/bju.13002.CrossRefPubMed

62.

Brooks J, Ellis SD, Jones E, Kimminau K, Thrasher JB. Role of social support in prostate cancer treatment decisions: physician perceptions and practices. Boston: AcademyHealth; 2016.

63.

Ganz PA, Barry JM, Burke W, Col NF, Corso PS, Dodson E, et al. National Institutes of Health state-of-the-science conference: role of active surveillance in the management of men with localized prostate cancer. Ann Intern Med. 2012;156(8):591–5. https://doi.org/10.7326/0003-4819-156-8-201204170-00010.CrossRefPubMedPubMedCentral

64.

Phillips LA, Leventhal EA, Leventhal H. Factors associated with the accuracy of physicians' predictions of patient adherence. Patient Educ Couns. 2011;85(3):461–7. https://doi.org/10.1016/j.pec.2011.03.012.CrossRefPubMedPubMedCentral

65.

Zeller A, Taegtmeyer A, Martina B, Battegay E, Tschudi P. Physicians' ability to predict patients' adherence to antihypertensive medication in primary care. Hypertens Res. 2008;31(9):1765–71. https://doi.org/10.1291/hypres.31.1765.CrossRefPubMed

66.

Ellis SD, Kimminau K, Jones EV, Petty L, Ellerbeck E, Thrasher JB. Potential barriers to use of prostate cancer treatment decision Aids in urology practice. Boston: AcademyHealth; 2016.

67.

Wang EH, Gross CP, Tilburt JC, Yu JB, Nguyen PL, Smaldone MC, et al. Shared decision making and use of decision AIDS for localized prostate cancer : perceptions from radiation oncologists and urologists. JAMA Intern Med. 2015;175(5):792–9. https://doi.org/10.1001/jamainternmed.2015.63.CrossRefPubMed

68.

Makarov DV, Sedlander E, Braithwaite RS, Sherman SE, Zeliadt S, Gross CP, et al. A qualitative study to understand guideline-discordant use of imaging to stage incident prostate cancer. Implement Sci. 2016;11(1):118. https://doi.org/10.1186/s13012-016-0484-5.CrossRefPubMedPubMedCentral

69.

Saul S. Profit and questions as doctors offer prostate cancer therapy. The New York Times. Vol. December 1, 2006. New York: The New York Times Company; 2006.

70.

Carreyrou J, Tamman M. A device to kill cancer, lift revenue: The wall street journal; 2010.

71.

Mitchell JM. Urologists' self-referral for pathology of biopsy specimens linked to increased use and lower prostate cancer detection. Health Aff (Millwood). 2012;31(4):741–9. https://doi.org/10.1377/hlthaff.2011.1372.CrossRef

72.

Mitchell JM. Urologists’ use of intensity-modulated radiation therapy for prostate cancer. N Engl J Med. 2013;369(17):1629–37. https://doi.org/10.1056/NEJMsa1201141.CrossRefPubMed

73.

Jacobs BL, Zhang Y, Schroeck FR, Skolarus TA, Wei JT, Montie JE, et al. Use of advanced treatment technologies among men at low risk of dying from prostate cancer. JAMA. 2013;309(24):2587–95. https://doi.org/10.1001/jama.2013.6882.CrossRefPubMed

74.

Elliott SP, Jarosek SL, Wilt TJ, Virnig BA. Reduction in physician reimbursement and use of hormone therapy in prostate cancer. J Natl Cancer Inst. 2010;102(24):1826–34. https://doi.org/10.1093/jnci/djq417.CrossRefPubMedPubMedCentral

75.

Shahinian VB, Kuo YF, Gilbert SM. Reimbursement policy and androgen-deprivation therapy for prostate cancer. N Engl J Med. 2010;363(19):1822–32. https://doi.org/10.1056/NEJMsa0910784.CrossRefPubMed

76.

O'Shaughnessy MJ, Jarosek SL, Virnig BA, Konety BR, Elliott SP. Factors associated with reduction in use of neoadjuvant androgen suppression therapy before radical prostatectomy. Urology. 2013;81(4):745–51. https://doi.org/10.1016/j.urology.2012.12.044.CrossRefPubMed

77.

Shahinian VB, Kuo YF. Reimbursement cuts and changes in urologist use of androgen deprivation therapy for prostate cancer. BMC Urol. 2015;15(1):25. https://doi.org/10.1186/s12894-015-0020-y.CrossRefPubMedPubMedCentral

78.

Loeb S, Walter D, Curnyn C, Gold HT, Lepor H, Makarov DV. How active is active surveillance? Intensity of Followup during active surveillance for prostate cancer in the United States. J Urol. 2016;196(3):721–6. https://doi.org/10.1016/j.juro.2016.02.2963.CrossRefPubMedPubMedCentral

79.

Zeliadt SB, Ramsey SD, Penson DF, Hall IJ, Ekwueme DU, Stroud L, et al. Why do men choose one treatment over another?: a review of patient decision making for localized prostate cancer. Cancer. 2006;106(9):1865–74. https://doi.org/10.1002/cncr.21822.CrossRefPubMed

80.

Zeliadt SB, Ramsey SD, Van Den Eeden SK, Hamilton AS, Oakley-Girvan I, Penson DF, et al. Patient recruitment methods to evaluate treatment decision making for localized prostate cancer. Am J Clin Oncol. 2010;33(4):381–6. https://doi.org/10.1097/COC.0b013e3181b215d5.CrossRefPubMed

Title: Perceived barriers to the adoption of active surveillance in low-risk prostate cancer: a qualitative analysis of community and academic urologists
Authors: Shellie D. Ellis
Soohyun Hwang
Emily Morrow
Kim S. Kimminau
Kelly Goonan
Laurie Petty
Edward Ellerbeck
J. Brantley Thrasher
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Prostate Cancer
Prostate Cancer
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08386-3

2024 ASCO Annual Meeting Coverage

Highlights of the Day: Breast cancer – metastatic

Breast Cancer Video

In this session, Dr. Wolff provides his key takeaways from the data presented in the metastatic breast cancer oral abstract session at ASCO 2024.

Watch now

Highlights of the Day: Gynecologic cancer

Gynecologic Cancer Video

Highlights of the Day: Breast Cancer – local/regional/adjuvant

Breast Cancer Video

Neoadjuvant dual immunotherapy improves melanoma outcomes

04-06-2024 Melanoma News

» View more highlights on the ASCO 2024 congress hub page

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Image Credits

ASCO 2024 | Highlights of the Day: Breast cancer – metastatic/© 2024 American Society of Clinical Oncology, all rights reserved., ASCO 2024 | Highlights of the Day: Gynecologic Cancer/© 2024 American Society of Clinical Oncology, all rights reserved., ASCO 2024 | Highlights of the Day: Breast Cancer – local/regional/adjuvant/© 2024 American Society of Clinical Oncology, all rights reserved., Melanoma/© selvanegra / Getty Images / iStock, Antibody drug conjugated with cytotoxic payload/© Love Employee / Getty images / iStock

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Synchronous bone metastasis in lung cancer: retrospective study of a single center of 15,716 patients from Tianjin, China

Nomograms predicting the overall survival and cancer-specific survival of patients with stage IIIC1 cervical cancer

Associations of specific-age and decade recall body mass index trajectories with obesity-related cancer

Identification of C3 and FN1 as potential biomarkers associated with progression and prognosis for clear cell renal cell carcinoma

Nodular lymphocyte-predominant Hodgkin lymphoma characteristics, management of primary and relapsed/refractory disease and outcome analysis: the first comprehensive report from the Middle East