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Alice B Kornblith - One of the best experts on this subject based on the ideXlab platform.

  • national institutes of health Consensus Development conference statement adjuvant therapy for breast cancer november 1 3 2000
    2001
    Co-Authors: Patricia J Eifel, J A Axelson, J Costa, J Crowley, Walter J Curran, A Deshler, S Fulton, C B Hendricks, M Kemeny, Alice B Kornblith
    Abstract:

    Objective Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer. Participants The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000. Evidence The literature was searched with the use of MEDLINE(TM) for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience. Consensus process The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://Consensus.nih.gov. Conclusions The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination.

  • national institutes of health Consensus Development conference statement adjuvant therapy for breast cancer november 1 3 2000
    2001
    Co-Authors: Patricia J Eifel, J A Axelson, J Costa, J Crowley, Walter J Curran, A Deshler, S Fulton, C B Hendricks, M Kemeny, Alice B Kornblith
    Abstract:

    OBJECTIVE: Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer. PARTICIPANTS: The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000. EVIDENCE: The literature was searched with the use of MEDLINE(TM) for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience. Consensus PROCESS: The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://Consensus.nih.gov. CONCLUSIONS: The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination.

Nancy J Rehrer - One of the best experts on this subject based on the ideXlab platform.

  • statement of the 3rd international exercise associated hyponatremia Consensus Development conference carlsbad california 2015
    2015
    Co-Authors: Tamara Hewbutler, Mitchell H Rosner, Sandra Fowkesgodek, Jonathan P Dugas, Martin D Hoffman, Douglas P Lewis, Ronald J Maughan, Kevin C Miller, Scott J Montain, Nancy J Rehrer
    Abstract:

    The 3rd International Exercise-Associated Hyponatremia (EAH) Consensus Development Conference convened in Carlsbad, California, in February 2015, with a panel of 17 international experts. The delegates represented four countries and nine medical and scientific subspecialties pertaining to athletic training, exercise physiology, sports medicine, water/sodium metabolism and body fluid homoeostasis. The primary goal of the panel was to review the existing data on EAH and update the 2008 Consensus Statement.1 This document serves to replace the 2nd International EAH Consensus Development Conference Statement and launch an educational campaign designed to address the morbidity and mortality associated with a preventable and treatable fluid imbalance . The following statement is a summary of the data synthesised by the 2015 EAH Consensus Panel and represents an evolution of the most current knowledge on EAH. This document will summarise the most current information on the prevalence, aetiology, diagnosis, treatment and prevention of EAH for medical personnel, athletes, athletic trainers and the greater public. The EAH Consensus Panel strove to clearly articulate what we agreed on, did not agree on and did not know, including minority viewpoints that were supported by clinical experience and experimental data. Further updates will be necessary to: (1) remain current with our understanding and (2) critically assess the effectiveness of our present recommendations. Suggestions for future research and educational strategies to reduce the incidence and prevalence of EAH are provided at the end of the document; areas of controversy that remain in this topic have also been outlined. The 3rd International EAH Consensus Development Conference utilised National Institutes of Health guidelines, amended for a more holistic approach to fit the needs of both the group and the topic. Twenty-two individuals (17 accepted) were invited to participate in the Consensus conference who: (1) have made scientific and/or clinical contributions to the topic …

  • statement of the third international exercise associated hyponatremia Consensus Development conference carlsbad california 2015
    2015
    Co-Authors: Tamara Hewbutler, Mitchell H Rosner, Sandra Fowkesgodek, Jonathan P Dugas, Martin D Hoffman, Douglas P Lewis, Ronald J Maughan, Kevin C Miller, Scott J Montain, Nancy J Rehrer
    Abstract:

    Tamara Hew-Butler, DPM, PhD,* Mitchell H. Rosner, MD,† Sandra Fowkes-Godek, PhD, ATC,‡ Jonathan P. Dugas, PhD,§ Martin D. Hoffman, MD,¶ Douglas P. Lewis, MD,k Ronald J. Maughan, PhD,** Kevin C. Miller, PhD, ATC,†† Scott J. Montain, PhD,‡‡ Nancy J. Rehrer, PhD,§§ William O. Roberts, MD, MSc,¶¶ Ian R. Rogers, MBBS,kk Arthur J. Siegel, MD,*** Kristin J. Stuempfle, PhD,††† James M. Winger, MD,‡‡‡ and Joseph G. Verbalis, MD§§§

  • statement of the second international exercise associated hyponatremia Consensus Development conference new zealand 2007
    2008
    Co-Authors: Tamara Hewbutler, Ronald J Maughan, Nancy J Rehrer, Carlos J Ayus, Courtney Kipps, Samuel Mettler, Willem H Meeuwisse, Anthony J Page, Stephen A Reid, William O Roberts
    Abstract:

    Tamara Hew-Butler, DPM, PhD,* J. Carlos Ayus, MD,† Courtney Kipps, BMBS, MSc,‡ Ronald J. Maughan, PhD,§ Samuel Mettler, MSc,¶ Willem H. Meeuwisse, MD, PhD (chair),k Anthony J. Page, MBChB, MD,** Stephen A. Reid, MBBS, PhD,†† Nancy J. Rehrer, PhD,‡‡ William O. Roberts, MD, MSc,§§ Ian R. Rogers, MBBS,¶¶ Mitchell H. Rosner, MD,kk Arthur J. Siegel, MD,*** Dale B. Speedy, MBChB, MD,††† Kristin J. Stuempfle, PhD,‡‡‡ Joseph G. Verbalis, MD,§§§ Louise B. Weschler, MAT, PT,¶¶¶ and Paul Wharam, MMedSckkk

Tamara Hewbutler - One of the best experts on this subject based on the ideXlab platform.

  • statement of the 3rd international exercise associated hyponatremia Consensus Development conference carlsbad california 2015
    2015
    Co-Authors: Tamara Hewbutler, Mitchell H Rosner, Sandra Fowkesgodek, Jonathan P Dugas, Martin D Hoffman, Douglas P Lewis, Ronald J Maughan, Kevin C Miller, Scott J Montain, Nancy J Rehrer
    Abstract:

    The 3rd International Exercise-Associated Hyponatremia (EAH) Consensus Development Conference convened in Carlsbad, California, in February 2015, with a panel of 17 international experts. The delegates represented four countries and nine medical and scientific subspecialties pertaining to athletic training, exercise physiology, sports medicine, water/sodium metabolism and body fluid homoeostasis. The primary goal of the panel was to review the existing data on EAH and update the 2008 Consensus Statement.1 This document serves to replace the 2nd International EAH Consensus Development Conference Statement and launch an educational campaign designed to address the morbidity and mortality associated with a preventable and treatable fluid imbalance . The following statement is a summary of the data synthesised by the 2015 EAH Consensus Panel and represents an evolution of the most current knowledge on EAH. This document will summarise the most current information on the prevalence, aetiology, diagnosis, treatment and prevention of EAH for medical personnel, athletes, athletic trainers and the greater public. The EAH Consensus Panel strove to clearly articulate what we agreed on, did not agree on and did not know, including minority viewpoints that were supported by clinical experience and experimental data. Further updates will be necessary to: (1) remain current with our understanding and (2) critically assess the effectiveness of our present recommendations. Suggestions for future research and educational strategies to reduce the incidence and prevalence of EAH are provided at the end of the document; areas of controversy that remain in this topic have also been outlined. The 3rd International EAH Consensus Development Conference utilised National Institutes of Health guidelines, amended for a more holistic approach to fit the needs of both the group and the topic. Twenty-two individuals (17 accepted) were invited to participate in the Consensus conference who: (1) have made scientific and/or clinical contributions to the topic …

  • statement of the third international exercise associated hyponatremia Consensus Development conference carlsbad california 2015
    2015
    Co-Authors: Tamara Hewbutler, Mitchell H Rosner, Sandra Fowkesgodek, Jonathan P Dugas, Martin D Hoffman, Douglas P Lewis, Ronald J Maughan, Kevin C Miller, Scott J Montain, Nancy J Rehrer
    Abstract:

    Tamara Hew-Butler, DPM, PhD,* Mitchell H. Rosner, MD,† Sandra Fowkes-Godek, PhD, ATC,‡ Jonathan P. Dugas, PhD,§ Martin D. Hoffman, MD,¶ Douglas P. Lewis, MD,k Ronald J. Maughan, PhD,** Kevin C. Miller, PhD, ATC,†† Scott J. Montain, PhD,‡‡ Nancy J. Rehrer, PhD,§§ William O. Roberts, MD, MSc,¶¶ Ian R. Rogers, MBBS,kk Arthur J. Siegel, MD,*** Kristin J. Stuempfle, PhD,††† James M. Winger, MD,‡‡‡ and Joseph G. Verbalis, MD§§§

  • statement of the second international exercise associated hyponatremia Consensus Development conference new zealand 2007
    2008
    Co-Authors: Tamara Hewbutler, Ronald J Maughan, Nancy J Rehrer, Carlos J Ayus, Courtney Kipps, Samuel Mettler, Willem H Meeuwisse, Anthony J Page, Stephen A Reid, William O Roberts
    Abstract:

    Tamara Hew-Butler, DPM, PhD,* J. Carlos Ayus, MD,† Courtney Kipps, BMBS, MSc,‡ Ronald J. Maughan, PhD,§ Samuel Mettler, MSc,¶ Willem H. Meeuwisse, MD, PhD (chair),k Anthony J. Page, MBChB, MD,** Stephen A. Reid, MBBS, PhD,†† Nancy J. Rehrer, PhD,‡‡ William O. Roberts, MD, MSc,§§ Ian R. Rogers, MBBS,¶¶ Mitchell H. Rosner, MD,kk Arthur J. Siegel, MD,*** Dale B. Speedy, MBChB, MD,††† Kristin J. Stuempfle, PhD,‡‡‡ Joseph G. Verbalis, MD,§§§ Louise B. Weschler, MAT, PT,¶¶¶ and Paul Wharam, MMedSckkk

Paul J Martin - One of the best experts on this subject based on the ideXlab platform.

  • national institutes of health Consensus Development project on criteria for clinical trials in chronic graft versus host disease vi the 2014 clinical trial design working group report
    2015
    Co-Authors: Paul J Martin, Paul A Carpenter, Linda M Griffith, Donna Przepiorka, Mary M Horowitz, John Koreth, Georgia Boyce Vogelsang, Irwin Walker, Gorgun Akpek, Mohamad Mohty
    Abstract:

    Abstract Treatment of chronic graft-versus-host disease is intended to produce a sustainable benefit by reducing symptom burden, controlling objective manifestations of disease activity, preventing damage and impairment, and improving overall survival without causing disproportionate harms related to the treatment itself. Successful management can control the disease until systemic treatment is no longer needed. The complexity of the disease, the extended duration of follow-up needed to observe disease resolution and withdrawal of immunosuppressive treatment, and the lack of fully developed shorter term endpoints impede progress in the field. Identification and characterization of primary endpoints demonstrating clinical benefit without requiring years of follow-up is urgently needed, with the understanding that clinical benefit encompasses not only the self-evident benefit of the primary endpoint but also any other associated benefits. This report discusses regulatory considerations, eligibility criteria, the value of controlled trial designs, the merits of proposed primary endpoints, and key considerations elaborated from experience and progress during the past decade. The report concludes by mapping an overall approach that could support and lead to maximally informative clinical trials, especially those that seek to demonstrate clinical benefit along a pathway to regulatory review and approval.

  • global and organ specific chronic graft versus host disease severity according to the 2005 nih Consensus criteria
    2011
    Co-Authors: Sally Arai, Mary E D Flowers, Madan Jagasia, Mukta Arora, Daniel J Weisdorf, Joseph Pidala, Corey Cutler, Barry E Storer, Xiaoyu Chai, Paul J Martin
    Abstract:

    In 2005, the National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic GVHD proposed a new scoring system for individual organs and an algorithm for calculating global severity (mild, moderate, severe). The Chronic GVHD Consortium was established to test these new criteria. This report includes the first 298 adult patients enrolled at 5 centers of the Consortium. Patients were assessed every 3-6 months using standardized forms recommended by the Consensus Conference. At the time of study enrollment, global chronic GVHD severity was mild in 10% (n = 32), moderate in 59% (n = 175), and severe in 31% (n = 91). Skin, lung, or eye scores determined the global severity score in the majority of cases, with the other 5 organs determining 16% of the global severity scores. Conventional risk factors predictive for onset of chronic GVHD and nonrelapse mortality in people with chronic GVHD were not associated with NIH global severity scores. Global severity scores at enrollment were associated with nonrelapse mortality (P < .0001) and survival (P < .0001); 2-year overall survival was 62% (severe), 86% (moderate), and 97% (mild). Patients with mild chronic GVHD have a good prognosis, while patients with severe chronic GVHD have a poor prognosis. This study was registered at www.clinicaltrials.gov as no. NCT00637689.

  • national institutes of health Consensus Development project on criteria for clinical trials in chronic graft versus host disease vi design of clinical trials working group report
    2006
    Co-Authors: Paul J Martin, Daniel J Weisdorf, Donna Przepiorka, Steven Hirschfeld, Ann T Farrell, Douglas J Rizzo, Ronan Foley, G Socie, Shelly L Carter, Daniel R Couriel
    Abstract:

    The complexity of chronic graft-versus-host disease (GVHD) and the lack of established research methods have made it difficult to design, conduct, and analyze clinical trials involving subjects with this disease, even when promising treatment options are available. This Consensus document was developed to offer an approach for overcoming these obstacles. Clinical trials in chronic GVHD should adhere to principles of good trial design and practice. Inclusion and exclusion criteria should allow as many subjects to participate as possible without compromising the interpretation of results. Pre-enrollment assessment of chronic GVHD characteristics should be standardized. The protocol should provide clear guidance about administration of study medication and other interventions. Methods of assessing response should be defined and validated in advance. Efficacy endpoints should be selected to reflect clinical benefit. Expert biostatistical support is needed to ensure the validity and reliability of trial results. The use of consistent standards in clinical trial designs to evaluate agents that have activity in pathogenic pathways could facilitate advances in the treatment of chronic GVHD.

Patricia J Eifel - One of the best experts on this subject based on the ideXlab platform.

  • national institutes of health Consensus Development conference statement adjuvant therapy for breast cancer november 1 3 2000
    2001
    Co-Authors: Patricia J Eifel, J A Axelson, J Costa, J Crowley, Walter J Curran, A Deshler, S Fulton, C B Hendricks, M Kemeny, Alice B Kornblith
    Abstract:

    Objective Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer. Participants The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000. Evidence The literature was searched with the use of MEDLINE(TM) for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience. Consensus process The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://Consensus.nih.gov. Conclusions The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination.

  • national institutes of health Consensus Development conference statement adjuvant therapy for breast cancer november 1 3 2000
    2001
    Co-Authors: Patricia J Eifel, J A Axelson, J Costa, J Crowley, Walter J Curran, A Deshler, S Fulton, C B Hendricks, M Kemeny, Alice B Kornblith
    Abstract:

    OBJECTIVE: Our goal was to provide health-care providers, patients, and the general public with an assessment of currently available data regarding the use of adjuvant therapy for breast cancer. PARTICIPANTS: The participants included a non-Federal, non-advocate, 14-member panel representing the fields of oncology, radiology, surgery, pathology, statistics, public health, and health policy as well as patient representatives. In addition, 30 experts in medical oncology, radiation oncology, biostatistics, epidemiology, surgical oncology, and clinical trials presented data to the panel and to a conference audience of 1000. EVIDENCE: The literature was searched with the use of MEDLINE(TM) for January 1995 through July 2000, and an extensive bibliography of 2230 references was provided to the panel. Experts prepared abstracts for their conference presentations with relevant citations from the literature. Evidence from randomized clinical trials and evidence from prospective studies were given precedence over clinical anecdotal experience. Consensus PROCESS: The panel, answering predefined questions, developed its conclusions based on the evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately after its release at the conference and was updated with the panel's final revisions. The statement is available at http://Consensus.nih.gov. CONCLUSIONS: The panel concludes that decisions regarding adjuvant hormonal therapy should be based on the presence of hormone receptor protein in tumor tissues. Adjuvant hormonal therapy should be offered only to women whose tumors express hormone receptor protein. Because adjuvant polychemotherapy improves survival, it should be recommended to the majority of women with localized breast cancer regardless of lymph node, menopausal, or hormone receptor status. The inclusion of anthracyclines in adjuvant chemotherapy regimens produces a small but statistically significant improvement in survival over non-anthracycline-containing regimens. Available data are currently inconclusive regarding the use of taxanes in adjuvant treatment of lymph node-positive breast cancer. The use of adjuvant dose-intensive chemotherapy regimens in high-risk breast cancer and of taxanes in lymph node-negative breast cancer should be restricted to randomized trials. Ongoing studies evaluating these treatment strategies should be supported to determine if such strategies have a role in adjuvant treatment. Studies to date have included few patients older than 70 years. There is a critical need for trials to evaluate the role of adjuvant chemotherapy in these women. There is evidence that women with a high risk of locoregional tumor recurrence after mastectomy benefit from postoperative radiotherapy. This high-risk group includes women with four or more positive lymph nodes or an advanced primary cancer. Currently, the role of postmastectomy radiotherapy for patients with one to three positive lymph nodes remains uncertain and should be tested in a randomized controlled trial. Individual patients differ in the importance they place on the risks and benefits of adjuvant treatments. Quality of life needs to be evaluated in selected randomized clinical trials to examine the impact of the major acute and long-term side effects of adjuvant treatments, particularly premature menopause, weight gain, mild memory loss, and fatigue. Methods to support shared decision-making between patients and their physicians have been successful in trials; they need to be tailored for diverse populations and should be tested for broader dissemination.