OBJECTIVES: To assess utilization pattern and appropriateness of anti-cancer drugs as adjuvant and neo-adjuvant therapy in patients of breast cancer. METHODS: In a prospective study medication orders of patients on chemotherapy for breast cancer were reviewed and patients were interviewed to assess treatment pattern and its appropriateness in an oncology hospital. Clinical stage of the disease, tumor characteristics, drug selection, dose, route, administration technique and anti-emetics used were reviewed with respect to standard international recommendations to evaluate the appropriateness of the chemotherapy.  RESULTS: One hundred patients were followed over six months. Use of anthracycline-based regimens was found to be higher (92%) compared to cyclophosphamide, methotrexate and 5-flurouracil regimen (6%). Targeted therapy was prescribed to only 33% of patients with HER2 positive tumor. Endocrine therapy, as either anti-estrogens or aromatase inhibitor was prescribed for 18 (100%) patients with hormone responsive tumor and for 7 of 13 patients with unknown hormone response status. Selection of chemotherapy regimen was appropriate in 84% patients. Cost of the therapy was the limiting factor to select an appropriate regimen for the other patients. Doses of anti-cancer agents were not calculated as per body surface area during subsequent cycle for 22% cases. Inappropriate administration of drugs was found due to excess dilution of drugs (25%) and improper infusion time (29%). Choice of anti-emetics was inappropriate in 38% cases and they were used at higher doses in 35% cases. CONCLUSIONS: Selection of anti-cancer agents was observed to be well compliant with standard international recommendations. However, lack of adherence to the prescribed chemotherapy was found higher due to inappropriate administration. Use of targeted therapy was limited due to economic considerations. Cost was the limiting factor to select an appropriate treatment for patients under government reimbursement scheme. Appropriate training to nurses can improve the delivery of chemotherapy.