Appendix: Physician Survey Document

We are studying how medical oncologists in Wisconsin choose adjuvant therapy for Her2+ breast cancer. All responses are considered standard of care and there are no wrong answers. Data will be aggregated by the UW Carbone Cancer Center Shared Survey Service, and we will not be able to identify the answers of any individual oncologist.

We intend to publish these data in a peer-reviewed journal in conjunction with a chart review of the experience at the UWCCC and the Marshfield Clinic. We do not have financial relationships with producers of these drugs. We have no vested interest in the result.

We appreciate your assistance.

Gabrielle Rocque MD, Oncology Fellow

Mark Burkard, MD, PhD, Assistant Professor

Amye Tevaarwerk, MD, Assistant Professor

Kari Wisinski, MD, Assistant Professor

University of Wisconsin Carbone Cancer Center

1.  Have you given adjuvant chemotherapy for breast cancer within the last 5 years?

  1. Yes – please continue to question 2
  2. No - end survey

2.  How many years have you practiced oncology since completing fellowship training?

  1. <2 years
  2. 2-5 years
  3. 6-10 years
  4. 11-20 years
  5. >20 years

3.  In the past 2 years, approximately how many approximately patients have you treated with neoadjuvant or adjuvant therapy for Her2+ breast cancer?

  1. 0
  2. 1
  3. 2-4
  4. 5-9
  5. ≥10

4.  What is the regimen you use most commonly for adjuvant therapy of Her2+ breast cancer in otherwise healthy patients?

  1. Anthracycline and trastuzumab based regimen (e.g. AC-TH)
  2. TCH (docetaxel, carboplatin, trastuzumab)
  3. Other

5.  How often do you choose these regimens:

Graded selection bar

0% 100% TCH

100% 0% AC-TH or other anthracycline-based

GRID:

6.  In a healthy premenopausal woman, what do you recommend most often for adjuvant systemic treatment of an ER-PR- Her2+ cancer with the following stage:

0.1-0.5 cm node negative (T1aN0M0)

0.6-1.0 cm node negative (T1bN0M0)

1.1-2.0 cm node negative (T1cN0M0)

2.1-5.0 cm node negative (T2N0M0)

node positive (TanyN1-3M0)

answers for grid

  1. No adjuvant therapy
  2. Trastuzumab only
  3. TCH (docetaxel, carboplatin, trastuzumab)
  4. Anthracycline and taxane-based with trastuzumab (e.g. AC-TH)
  5. Anthracline-based and trastuzumab without taxane (e.g. AC-H)
  6. TC - H (docetaxel and cyclophosphamide followed by trastuzumab)

7.  Would any of the following change your chemotherapy of choice in the patient above with node+ Her2+ breast cancer (please select all that apply)?

  1. Cardiac disease (CAD, CHF, etc.)
  2. Chronic renal insufficiency
  3. History of anthracycline therapy for prior malignancy
  4. Patient age
  5. Patient concerns about cardiotoxicity
  6. Patient concerns about treatment efficacy

8.  How important is each of the following factors on your selection of chemotherapy when treating node+ Her2+ breast cancer (4 options): RANDOMIZE ORDER OF ANSWERS

  1. Uniformity of practice with my colleagues
  2. Personal experience with regimen
  3. Minimizing the total duration of therapy
  4. Belief that regimen is better tolerated
  5. Concern about cardiotoxicity
  6. Risk of secondary leukemia
  7. Initiation of trastuzumab with cycle 1 of therapy.
  8. Maximize likelihood of completing 1 year of trastuzumab therapy
  9. Preclinical data showing effect of drugs on Her2+ cell lines and tumor models
  10. Long track record of regimen for adjuvant therapy
  11. Sponsor that funded clinical trial
  12. Belief that regimen has better efficacy (e.g. minimize risk of relapse)
  13. Publication in peer-reviewed journal

9.  In your opinion, which regimen is most likely to be completed without dose delays or interruptions:

a. AC-TH (anthracycline, cyclophosphamide, taxane, trastuzumab)

b. TCH (docetaxel, carboplatin, trastuzumab)

c. equal

GRID:

10.  Describe your preferred use of GCSF (filgrastim or pegfilgrastim) with cycle 1 of treatment in the following regimens:

TCH (docetaxel, carboplatin, trastuzumab)

AC-TH (anthracycline, cyclophosphamide, taxane, trastuzumab)

  1. pegfilgrastim
  2. filgrastim
  3. no routine GCSF

11.  Which of the following laboratory value do you check prior to giving each cycle of your adjuvant chemotherapy regimen of choice for Her2+ breast cancer (multiple selections)?

  1. CBC with ANC
  2. Creatinine
  3. One or more liver function tests (AST, ALT, TBili, Alk phos)
  4. Potassium
  5. Magnesium
  6. Phosphorus

GRID:

12.  In the last 5 years, approximately how many of your patients have developed the following cardiac complications from treatment of Her2+ breast cancer:

Significant but asymptomatic decline in left ventricular function (LVEF)

Episode of symptomatic congestive heart failure

Early discontinuation of planned chemotherapy

Early discontinuation of planned trastuzumab

  1. 0
  2. 1
  3. 2-4
  4. 5-9
  5. ≥10

COMMENTS: