Provider level facilitators and barriers towards neoadjuvant chemotherapy for triple negative and HER2+ breast cancer in Ontario

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 study showed that only 23.9% of stage II-III TN or HER2+ BC patients in Ontario received NAC. A survey among 1005 surgeons in Ontario investigated provider level facilitators and barriers toward NAC in this patient population. Total response rate was 21.1%. All respondents who treated BC (71/71) reported being aware of indications and benefits of NAC for TN and HER2+ BC. Most respondents reported recommending NAC for node positive and node negative, > 2 cm TNBC (97.2%) and for node positive HER2+ (98.6%) but less likely to recommend NAC for node negative, > T2 (88.7%). Respondents perceived patient factors (e.g. age, comorbidities, patient’s fear of chemotherapy) as barriers towards receiving NAC. The authors conclude that 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.