Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer

Robert Peter Gale, Rolla Edward Park, Robert Dubois, Jacob D. Bitran, Aman Buzdar, Gabriel Hortobagyi, Stephen E. Jones, Gary S. Lazar, Gary Spitzer, Sandra M. Swain, Clarence B. Vaughn, Charles Vogel, Silvana Martino

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: There is controversy whether high-dose chemotherapy and a blood cell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory. Objective: Determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow autotransplant in women with breast cancer. Panelists: Nine breast cancer experts from diverse geographic sites and practice settings. Evidence: Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'. Process: We used a modified Delphi-panel group judgement process. Clinical variables were permuted to define 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. Conclusions: In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with ≥ 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with ≤ 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleura) and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those with bone metastases and a complete or partial response or stable disease after chemotherapy; and 3) inappropriate in other settings.

Original languageEnglish
Pages (from-to)32-41
Number of pages10
JournalClinical Transplantation
Volume14
Issue number1
DOIs
StatePublished - Feb 15 2000
Externally publishedYes

Fingerprint

Autografts
Blood Cells
Bone Marrow
Breast Neoplasms
Drug Therapy
Lymph Nodes
Neoplasm Metastasis
Neoplasms
Group Processes
Pleura
Therapeutics
MEDLINE
Patient Selection
Analysis of Variance
Central Nervous System
Transplants
Bone and Bones
Lung
Skin
Liver

Keywords

  • Autotransplants
  • Breast cancer
  • Delphi-panel analysis
  • High-dose chemotherapy

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer. / Gale, Robert Peter; Park, Rolla Edward; Dubois, Robert; Bitran, Jacob D.; Buzdar, Aman; Hortobagyi, Gabriel; Jones, Stephen E.; Lazar, Gary S.; Spitzer, Gary; Swain, Sandra M.; Vaughn, Clarence B.; Vogel, Charles; Martino, Silvana.

In: Clinical Transplantation, Vol. 14, No. 1, 15.02.2000, p. 32-41.

Research output: Contribution to journalArticle

Gale, RP, Park, RE, Dubois, R, Bitran, JD, Buzdar, A, Hortobagyi, G, Jones, SE, Lazar, GS, Spitzer, G, Swain, SM, Vaughn, CB, Vogel, C & Martino, S 2000, 'Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer', Clinical Transplantation, vol. 14, no. 1, pp. 32-41. https://doi.org/10.1034/j.1399-0012.2000.140107.x
Gale, Robert Peter ; Park, Rolla Edward ; Dubois, Robert ; Bitran, Jacob D. ; Buzdar, Aman ; Hortobagyi, Gabriel ; Jones, Stephen E. ; Lazar, Gary S. ; Spitzer, Gary ; Swain, Sandra M. ; Vaughn, Clarence B. ; Vogel, Charles ; Martino, Silvana. / Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer. In: Clinical Transplantation. 2000 ; Vol. 14, No. 1. pp. 32-41.
@article{6b3991e9025942b2b84337ccadabc14f,
title = "Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer",
abstract = "Background: There is controversy whether high-dose chemotherapy and a blood cell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory. Objective: Determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow autotransplant in women with breast cancer. Panelists: Nine breast cancer experts from diverse geographic sites and practice settings. Evidence: Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'. Process: We used a modified Delphi-panel group judgement process. Clinical variables were permuted to define 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. Conclusions: In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with ≥ 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with ≤ 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleura) and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those with bone metastases and a complete or partial response or stable disease after chemotherapy; and 3) inappropriate in other settings.",
keywords = "Autotransplants, Breast cancer, Delphi-panel analysis, High-dose chemotherapy",
author = "Gale, {Robert Peter} and Park, {Rolla Edward} and Robert Dubois and Bitran, {Jacob D.} and Aman Buzdar and Gabriel Hortobagyi and Jones, {Stephen E.} and Lazar, {Gary S.} and Gary Spitzer and Swain, {Sandra M.} and Vaughn, {Clarence B.} and Charles Vogel and Silvana Martino",
year = "2000",
month = "2",
day = "15",
doi = "10.1034/j.1399-0012.2000.140107.x",
language = "English",
volume = "14",
pages = "32--41",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in women with breast cancer

AU - Gale, Robert Peter

AU - Park, Rolla Edward

AU - Dubois, Robert

AU - Bitran, Jacob D.

AU - Buzdar, Aman

AU - Hortobagyi, Gabriel

AU - Jones, Stephen E.

AU - Lazar, Gary S.

AU - Spitzer, Gary

AU - Swain, Sandra M.

AU - Vaughn, Clarence B.

AU - Vogel, Charles

AU - Martino, Silvana

PY - 2000/2/15

Y1 - 2000/2/15

N2 - Background: There is controversy whether high-dose chemotherapy and a blood cell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory. Objective: Determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow autotransplant in women with breast cancer. Panelists: Nine breast cancer experts from diverse geographic sites and practice settings. Evidence: Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'. Process: We used a modified Delphi-panel group judgement process. Clinical variables were permuted to define 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. Conclusions: In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with ≥ 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with ≤ 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleura) and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those with bone metastases and a complete or partial response or stable disease after chemotherapy; and 3) inappropriate in other settings.

AB - Background: There is controversy whether high-dose chemotherapy and a blood cell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory. Objective: Determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow autotransplant in women with breast cancer. Panelists: Nine breast cancer experts from diverse geographic sites and practice settings. Evidence: Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'. Process: We used a modified Delphi-panel group judgement process. Clinical variables were permuted to define 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. Conclusions: In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with ≥ 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with ≤ 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleura) and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those with bone metastases and a complete or partial response or stable disease after chemotherapy; and 3) inappropriate in other settings.

KW - Autotransplants

KW - Breast cancer

KW - Delphi-panel analysis

KW - High-dose chemotherapy

UR - http://www.scopus.com/inward/record.url?scp=0033983628&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033983628&partnerID=8YFLogxK

U2 - 10.1034/j.1399-0012.2000.140107.x

DO - 10.1034/j.1399-0012.2000.140107.x

M3 - Article

C2 - 10693633

AN - SCOPUS:0033983628

VL - 14

SP - 32

EP - 41

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 1

ER -