Default from neoadjuvant chemotherapy in premenopausal female breast cancer patients: What is to blame?

Background: Breast cancer is the most frequent cancer among women in most parts of the world including Nigeria. Neoadjuvant chemotherapy has been demonstrated to be a helpful strategy in the context of locally advanced breast cancer. Aims: The purpose of this study was to investigate some factors that may contribute to low rate of acceptance and adherence to neoadjuvant chemotherapy. Materials and Methods: A 1-year prospective study of premenopausal women with locally advanced breast cancer recommended for neoadjuvant chemotherapy from June 2009 to May 2010. Results: Forty-four patients gave consent to be part of the study. The ages ranged from 26 to 51 years with a mean age of 42.1 years ± 7.7 years. Only 31 patients completed the four courses of NAC. Seventeen (38.6%) patients dropped out of treatment, before, during or after completing NAC. Ten of these defaulted due to inadequate funds to procure chemotherapy, three patients because they insisted on immediate mastectomy, and four of these patients refused surgery when they achieved complete clinical response, probably due to fear of mastectomy which is common among women in our environment. Twenty patients had dose deferment. Conclusion: Lack of funds to procure chemotherapy and refusal of additional modality of treatment are the two major factors responsible for default of NAC and its goal in patients with LABC.