Provider level facilitators and barriers towards neoadjuvant chemotherapy for triple negative and HER2 + breast cancer: a survey of Ontario surgeons.

[PURPOSE] Neoadjuvant chemotherapy (NAC) is considered standard of care for patients with cT2 + and/or N + triple negative (TN) and HER2-positive (HER2 +) breast cancer (BC). A previous retrospective study showed only 23.9% of stage II-III TN or HER2 + BC patients in Ontario received NAC. This study aimed to identify provider-level facilitators and barriers to using NAC as first-line treatment.

[METHODS] We surveyed General Surgeons in Ontario using a self-administered questionnaire developed through systematic item generation and reduction. We evaluated face and content validity, as well as test-retest reliability. Surveys were sent via mail delivery with reminder. Participants could also use a QR code to access the online version. Quantitative data were analysed with descriptive statistics and qualitative responses examined using open coding.

[RESULTS] Total response rate was 21.1% (212/1005). All respondents who treated BC (71/71) reported being aware of indications and benefits of NAC for TNBC and HER2 + BC. Most respondents reported recommending NAC for node positive and node negative, > 2 cm TNBC (97.2%) and were equally likely for node positive HER2 + (98.6%), but less likely for node negative, > T2 (88.7%). Respondents perceived patient factors (e.g. age and comorbidities and patient's fear of chemotherapy) as barriers towards receiving NAC. The most reported facilitator to NAC was access to multidisciplinary cancer conferences.

[CONCLUSION] Surgeons demonstrated strong knowledge of NAC's indications and benefits, indicating that low NAC rates are likely not due to lack of awareness. Patient factors remain the major barriers to NAC uptake.