6:28 AM
Zhao Yan
About 50 % of patients rich in-risk cancer of the breast don't receive radiotherapy after mastectomy, based on research released online June 27 in Cancer.
The finding is surprising because several major American treatment recommendations released within the late the nineteen nineties recommend radiation of these women after their surgery, stated lead author Benjamin Cruz, MD, in the College of Texas M.D. Anderson Cancer Center in Houston.
"I was expecting that using postmastectomy radiotherapy would rise in reaction to the released recommendations," he told Medscape Medical News.
The speed useful of the radiation did really rise in the mid-the nineteen nineties, following the publication of three landmark clinical tests that demonstrated that postmastectomy radiotherapy decreased locoregional recurrence and enhanced survival in patients rich in-risk cancer of the breast (stage T3 T4 and/or N2 N3), based on Dr. Cruz and the coauthors.
Many physicians obviously required notice from the released study results and added radiotherapy to treatment regimens.
Using postmastectomy radiotherapy in high-risk cancer of the breast elevated from 36.5% (95% confidence interval [CI], 26% to 46.9%) to 57.7% (95% CI, 46.9% to 68.4%) from 1996 to 1998, following the publication from the landmark clinical tests.
However the recommendations ?a including individuals in the American Society of Clinical Oncology and also the National Comprehensive Cancer Network (NCCN) ?a that adopted the released study results didn't have a similar impact.
There is no further rise in postmastectomy radiotherapy use between 1999 and 2005, regardless of the publication of multiple recommendations promoting its use, write the authors. Throughout this era, only 54.8% (2729 of 4978) of high-risk patients received the postsurgery therapy.
This issue of the low rate useful doesn't exist with radiation after lumpectomy, stated Dr. Cruz.
"I authored a somewhat similar study searching at using radiation following a lumpectomy in females to whom radiation is indicated. And most 90% of ladies really received radiation as suggested," he stated, stating earlier research (Int J Radiat Oncol Biol Phys. 200974:1506-1512).
"With each other, our results claim that compliance with radiation following a lumpectomy is very good, but compliance with radiation after mastectomy continues to be suboptimal," he stated.
Wrong?
Dr. Cruz and co-workers examined data on 38,332 women 66 years old or older who went through mastectomy for invasive cancer of the breast between 1992 and 2005, acquired in the Surveillance, Epidemiology, and Finish Results (SEER) Medicare insurance database, which links cancer registry data to some master file of Medicare insurance enrollment.
From the final amount of ladies, 23,126 (60.3%) were safe, 7,211 (18.8%) were intermediate risk, and 7,995 (20.9%) were high-risk.
The receipt of postmastectomy radiotherapy was strongly connected with risk group: 6.6% of low-risk, 16% of intermediate-risk, and 48.5% of high-risk patients received the treatment (P < .0001). Postsurgery radiation was also correlated with age at diagnosis, marital status, comorbidity, SEER registry, median income in Census tract or zip code, estrogen-receptor status, number of involved lymph nodes, and receipt of chemotherapy, report the authors.
The failure to use postmastectomy radiation therapy seems to be largely a problem in "broader clinical practice," suggest the authors.
For instance, another study found that postmastectomy radiation therapy was received by 83.6% of high-risk patients who were treated at NCCN institutions, the authors point out. This underlines "the large differential in adoption between specialized cancer centers and broader clinical practice as reflected in our SEER Medicare-derived cohort," they say.
So what's the problem?
"Postmastectomy radiation therapy may have been appropriately contraindicated in certain patients," say the authors. But this does not account for the fact that about half of high-risk women did not receive the recommended radiation, they say, citing a number of reasons.
The authors suspect that access plays a big part in the underuse of radiation in this setting. "In many instances, access to the radiation resources required to perform postmastectomy radiation therapy is deficient. There is evidence for this mechanism, because investigators have demonstrated that variables like the distance to a radiation oncology facility influence the receipt of [postmastectomy radiation therapy] by elderly patients," they write.
The authors also rule out some of the usual suspects that are blamed for poor access to radiation therapy.
"We observed that other surrogate factors usually implicated in radiation access, including neighborhood education level, race, income, and density of radiation oncologists, did not significantly influence rates of [postmastectomy radiation therapy] omission in our multivariate analysis," they report.
Patients might also be the reason behind the low rates of use, note the authors, who write that "many patients choose mastectomy with the specific bias of wishing to avoid radiotherapy therefore, it is possible that the omission of postmastectomy radiation therapy in some candidates may be attributable to this phenomenon."
The authors are concerned that the suboptimal use of radiation in this setting means suboptimal results for patients.
"When physicians are not guided by published evidence, there is the chance that patient outcomes will suffer or that patients will undergo unnecessary treatments and tests," said coauthor Shervin Shirvani, MD, in a press statement. He is also from the M.D. Anderson Cancer Center. "Furthermore, beyond the potential for distress and injury to the individual patient, there is also the strong likelihood that medical resources will be wasted on unproven or ineffective treatments."
The finding is surprising because several major American treatment recommendations released within the late the nineteen nineties recommend radiation of these women after their surgery, stated lead author Benjamin Cruz, MD, in the College of Texas M.D. Anderson Cancer Center in Houston.
"I was expecting that using postmastectomy radiotherapy would rise in reaction to the released recommendations," he told Medscape Medical News.
The speed useful of the radiation did really rise in the mid-the nineteen nineties, following the publication of three landmark clinical tests that demonstrated that postmastectomy radiotherapy decreased locoregional recurrence and enhanced survival in patients rich in-risk cancer of the breast (stage T3 T4 and/or N2 N3), based on Dr. Cruz and the coauthors.
Many physicians obviously required notice from the released study results and added radiotherapy to treatment regimens.
Using postmastectomy radiotherapy in high-risk cancer of the breast elevated from 36.5% (95% confidence interval [CI], 26% to 46.9%) to 57.7% (95% CI, 46.9% to 68.4%) from 1996 to 1998, following the publication from the landmark clinical tests.
However the recommendations ?a including individuals in the American Society of Clinical Oncology and also the National Comprehensive Cancer Network (NCCN) ?a that adopted the released study results didn't have a similar impact.
There is no further rise in postmastectomy radiotherapy use between 1999 and 2005, regardless of the publication of multiple recommendations promoting its use, write the authors. Throughout this era, only 54.8% (2729 of 4978) of high-risk patients received the postsurgery therapy.
This issue of the low rate useful doesn't exist with radiation after lumpectomy, stated Dr. Cruz.
"I authored a somewhat similar study searching at using radiation following a lumpectomy in females to whom radiation is indicated. And most 90% of ladies really received radiation as suggested," he stated, stating earlier research (Int J Radiat Oncol Biol Phys. 200974:1506-1512).
"With each other, our results claim that compliance with radiation following a lumpectomy is very good, but compliance with radiation after mastectomy continues to be suboptimal," he stated.
Wrong?
Dr. Cruz and co-workers examined data on 38,332 women 66 years old or older who went through mastectomy for invasive cancer of the breast between 1992 and 2005, acquired in the Surveillance, Epidemiology, and Finish Results (SEER) Medicare insurance database, which links cancer registry data to some master file of Medicare insurance enrollment.
From the final amount of ladies, 23,126 (60.3%) were safe, 7,211 (18.8%) were intermediate risk, and 7,995 (20.9%) were high-risk.
The receipt of postmastectomy radiotherapy was strongly connected with risk group: 6.6% of low-risk, 16% of intermediate-risk, and 48.5% of high-risk patients received the treatment (P < .0001). Postsurgery radiation was also correlated with age at diagnosis, marital status, comorbidity, SEER registry, median income in Census tract or zip code, estrogen-receptor status, number of involved lymph nodes, and receipt of chemotherapy, report the authors.
The failure to use postmastectomy radiation therapy seems to be largely a problem in "broader clinical practice," suggest the authors.
For instance, another study found that postmastectomy radiation therapy was received by 83.6% of high-risk patients who were treated at NCCN institutions, the authors point out. This underlines "the large differential in adoption between specialized cancer centers and broader clinical practice as reflected in our SEER Medicare-derived cohort," they say.
So what's the problem?
"Postmastectomy radiation therapy may have been appropriately contraindicated in certain patients," say the authors. But this does not account for the fact that about half of high-risk women did not receive the recommended radiation, they say, citing a number of reasons.
The authors suspect that access plays a big part in the underuse of radiation in this setting. "In many instances, access to the radiation resources required to perform postmastectomy radiation therapy is deficient. There is evidence for this mechanism, because investigators have demonstrated that variables like the distance to a radiation oncology facility influence the receipt of [postmastectomy radiation therapy] by elderly patients," they write.
The authors also rule out some of the usual suspects that are blamed for poor access to radiation therapy.
"We observed that other surrogate factors usually implicated in radiation access, including neighborhood education level, race, income, and density of radiation oncologists, did not significantly influence rates of [postmastectomy radiation therapy] omission in our multivariate analysis," they report.
Patients might also be the reason behind the low rates of use, note the authors, who write that "many patients choose mastectomy with the specific bias of wishing to avoid radiotherapy therefore, it is possible that the omission of postmastectomy radiation therapy in some candidates may be attributable to this phenomenon."
The authors are concerned that the suboptimal use of radiation in this setting means suboptimal results for patients.
"When physicians are not guided by published evidence, there is the chance that patient outcomes will suffer or that patients will undergo unnecessary treatments and tests," said coauthor Shervin Shirvani, MD, in a press statement. He is also from the M.D. Anderson Cancer Center. "Furthermore, beyond the potential for distress and injury to the individual patient, there is also the strong likelihood that medical resources will be wasted on unproven or ineffective treatments."
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