Resource-Stratified Matrix Guidelines

Treatment and Allocation of Resources: Metastatic (Stage IV) and Recurrent Breast Cancer

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Level of resources Local-regional treatment Systemic treatment (adjuvant)
Surgery
Radiation therapy
Chemo-therapy
Endocrine therapy
Supportive and palliative therapy
Basic

Total mastectomy for ipsilateral breast tumor recurrence*

   

Ovarian ablation

Tamoxifen

Nonopioid and opioid analgesics

Limited
  

Palliative radiation therapy

Classical CMF**

Anthracycline monotherapy or in combination**

   
Enhanced
    

Taxanes

Capecitabine

Trastuzumab

Aromatase inhibitors

Bisphosphonates

Maximal
    

Growth factors

Vinorelbine

Gemcitabine

Carboplatin

Fulvestrant

 

ABBREVIATIONS: CMF, cyclophosphamide, methotrexate, and 5-fluorouracil.

* Requires blood chemistry profile and complete blood count (CBC) testing

** Required resources are the same as those for modified radical mastectomy.


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