Implementation of adjuvant therapy for breast cancer in the St. Louis metropolitan area: 1976-1977

In order to determine the extent of implementation of adjuvant chemotherapy for stage II carcinoma of the breast in the St. Louis area, records of all patients with stage II carcinoma of the breast treated with standard or modified radical mastectomy in five different St. Louis hospitals were reviewed. Between July 1, 1976, and July 1, 1977 (17 months after publication of preliminary L‐PAM results and 4 months after publication of preliminary CMF results), 73% of 24 premenopausal patients and 55% of 58 postmenopausal patients received adjuvant chemotherapy. Ten percent of premenopausal and 31% of postmenopausal patients received therapy other than CMF or L‐PAM. Compared to premenopausal patients in university‐affiliated hospitals, premenopausal patients in community hospitals tended to receive radiation therapy more commonly and chemotherapy alone less often (P < 0.1). Compared to postmenopausal patients in university‐affiliated hospitals, postmenopausal patients in community hospitals more commonly received chemotherapy alone, and less often received no adjuvant therapy (P < 0.05). We conclude that results of adjuvant chemotherapy trials can be rapidly implemented into standard practice both in university‐affiliated and community hospitals. Since 12 of 52 patients receiving adjuvant chemotherapy in fact received non‐standard, unpublished regimens, improvements in phase IV drug development may be required to prevent potentially deleterious modifications of published recommendations.