Neoadjuvant systemic therapy in breast cancer – a multicentre, prospective national audit

Aims and objectives

NeST is a multicentre audit to evaluate current practice in the use of neoadjuvant systemic therapies (NST) to treat breast cancer. The audit aims to:

1. To establish current stated practice regarding the use of NST
2. To determine the current practice of NST, including:
   1. Indications for use
   2. Treatment modalities in common use
   3. Monitoring of response to treatment
   4. Pathological reporting of response to NST
3. To explore surgical decision-making in the context of NST with respect to both the breast and axilla
4. To explore the use of further adjuvant therapies (radiotherapy and systemic therapies) following NST
5. To determine pathological response rates to NST in routine clinical practice
6. To establish best practice with regard to the use of NST, with a view to generating national guidelines.

Methods

This is a trainee-led multicentre audit, co-ordinated by the members of the NeST steering group.

Trainees from across the U.K. in both breast surgery and medical/clinical oncology will be invited to participate in the study, through the Mammary Fold, the National Research Collaboratives and oncology trainee associations. A local trainee lead(s) will be identified at each centre. Trainee leads will be responsible for identifying a supervising consultant and obtaining the necessary local audit approvals at their centre. Where there are no trainees within a unit, consultant, associate specialists, specialty doctors or research nurses will be encouraged to participate and enter data on behalf of their units.

There will be two phases to the study:

1. A national practice questionnaire for MDTs, to determine stated practice within each unit
2. A prospective audit phase for six months, collecting data on all women offered neoadjuvant systemic therapy (either chemotherapy, hormonal therapy or targeted therapies) following MDT discussion.

Inclusion criteria for prospective audit:

• Age > 16 years
• Histologically confirmed diagnosis of breast cancer
• MDT recommended treatment of neoadjuvant systemic therapy – including patients entering into trials of NST.

Exclusion criteria for prospective audit:

• Patients entering “window of opportunity” clinical trials

Research Governance

This project is being conducted as a prospective clinical audit. Local collaborators will be required to register the project with their local audit department prior to commencing data collection.

No patient identifiable data will be collected for the purposes of the study.

Get involved

Please complete the form below to register as a collaborator. Don’t forget to use a NON-NHS email address!