Multidisciplinary Implementation of Neoadjuvant Therapy for Early Breast Cancer in a Middle-income Country-Real-world Challenges in Malaysia.

Aim: Neoadjuvant therapy (NAT) is not widely employed for the management of patients with early breast cancer (EBC) in Malaysia. We sought to identify barriers to NAT and explore solutions for improving equitable, safe, and timely access to NAT in these patients.

Methods: We used deliberative stakeholder consultation, a descriptive qualitative study design, for data collection. Sixteen breast cancer specialists (seven breast surgeons, seven clinical oncologists, one radiologist, and one pathologist) from 11 tertiary centers in Malaysia were purposively recruited. Deliberations were recorded, transcribed, and thematically analyzed to generate analytical and deliberative outputs. A literature search was performed to ensure that consensus statements were aligned with scientific evidence and clinical practice guidelines.

Results: Four barrier themes affecting NAT implementation were derived: (1) diagnostic delays, (2) lack of access to oncology services, (3) patient low acceptance of NAT, and (4) high treatment costs. We highlighted potential solutions to address each barrier. Seven key areas for improvement were identified across the EBC care pathway: (1) rational use of imaging modalities, (2) biopsy sampling technique, (3) standardized histopathological reporting, (4) patient selection for NAT, (5) marker clip insertion, (6) monitoring during NAT, and (7) surgical axillary management. Expert recommendations for practice-change interventions were in alignment with published international, national, and institutional guidelines.

Conclusion: Barriers to NAT in Malaysia are multifactorial. This study draws on a multidisciplinary stakeholder perspective to define real-world challenges faced by breast cancer specialists and provides recommendations for implementing guideline-recommended practices for NAT utilization in the local healthcare setting.