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Nosrati JD, Ma D, Bloom B, Kapur A, Sidiqi BU, Thakur R, Tchelebi LT, Herman JM, Adair N, Potters L, Chen WC. Treatment Terminations During Radiation Therapy: A 10-Year Experience. Pract Radiat Oncol 2024:S1879-8500(24)00142-5. [PMID: 38972541 DOI: 10.1016/j.prro.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/01/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Patients undergoing radiation therapy may terminate treatment for any number of reasons. The incidence of treatment termination (TT) during radiation therapy has not been studied. Herein, we present a cohort of TT at a large multicenter radiation oncology department over 10 years. METHODS AND MATERIALS TTs between January 2013 and January 2023 were prospectively analyzed as part of an ongoing departmental quality and safety program. TT was defined as any premature discontinuation of therapy after initiating radiation planning. The rate of TT was calculated as a percentage of all patients starting radiation planning. All cases were presented at monthly morbidity and mortality conferences with a root cause reviewed. RESULTS A total of 1448 TTs were identified out of 31,199 planned courses of care (4.6%). Six hundred eighty-six (47.4%) involved patients treated with curative intent, whereas 753 (52.0%) were treated with palliative intent, and 9 (0.6%) were treated for benign disease. The rate of TT decreased from 8.49% in 2013 to 3.02% in 2022, with rates decreasing yearly. The most common disease sites for TT were central nervous system (21.7%), head and neck (19.3%), thorax (17.5%), and bone (14.2%). The most common causes of TT were hospice and/or patient expiration (35.9%), patient choice unrelated to toxicity (35.2%), and clinician choice unrelated to toxicity (11.5%). CONCLUSIONS This 10-year prospective review of TTs identified a year-over-year decrease in TTs as a percentage of planned patients. This decrease may be associated with the addition of root cause reviews for TTs and discussions monthly at morbidity and mortality rounds, coupled with departmental upstream quality initiatives implemented over time. Understanding the reasons behind TTs may help decrease preventable TTs. Although some TTs may be unavoidable, open discourse and quality improvement changes effectively reduce TT incidents over time.
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Affiliation(s)
- Jason D Nosrati
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Daniel Ma
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Beatrice Bloom
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Ajay Kapur
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Baho U Sidiqi
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Richa Thakur
- Northwell, New Hyde Park, New York; Department of Hematology and Medical Oncology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Leila T Tchelebi
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Joseph M Herman
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Nilda Adair
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Louis Potters
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - William C Chen
- Northwell, New Hyde Park, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
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Bekele BB, Lian M, Schmaltz C, Greever-Rice T, Shrestha P, Liu Y. Preexisting Diabetes and Breast Cancer Treatment Among Low-Income Women. JAMA Netw Open 2024; 7:e249548. [PMID: 38717774 PMCID: PMC11079686 DOI: 10.1001/jamanetworkopen.2024.9548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/26/2024] [Indexed: 05/12/2024] Open
Abstract
IMPORTANCE Diabetes is associated with poorer prognosis of patients with breast cancer. The association between diabetes and adjuvant therapies for breast cancer remains uncertain. OBJECTIVE To comprehensively examine the associations of preexisting diabetes with radiotherapy, chemotherapy, and endocrine therapy in low-income women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included women younger than 65 years diagnosed with nonmetastatic breast cancer from 2007 through 2015, followed up through 2016, continuously enrolled in Medicaid, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. Data were analyzed from January 2022 to October 2023. EXPOSURE Preexisting diabetes. MAIN OUTCOMES AND MEASURES Logistic regression was used to estimate odds ratios (ORs) of utilization (yes/no), timely initiation (≤90 days postsurgery), and completion of radiotherapy and chemotherapy, as well as adherence (medication possession ratio ≥80%) and persistence (<90-consecutive day gap) of endocrine therapy in the first year of treatment for women with diabetes compared with women without diabetes. Analyses were adjusted for sociodemographic and tumor factors. RESULTS Among 3704 women undergoing definitive surgery, the mean (SD) age was 51.4 (8.6) years, 1038 (28.1%) were non-Hispanic Black, 2598 (70.1%) were non-Hispanic White, 765 (20.7%) had a diabetes history, 2369 (64.0%) received radiotherapy, 2237 (60.4%) had chemotherapy, and 2505 (67.6%) took endocrine therapy. Compared with women without diabetes, women with diabetes were less likely to utilize radiotherapy (OR, 0.67; 95% CI, 0.53-0.86), receive chemotherapy (OR, 0.67; 95% CI, 0.48-0.93), complete chemotherapy (OR, 0.71; 95% CI, 0.50-0.99), and be adherent to endocrine therapy (OR, 0.71; 95% CI, 0.56-0.91). There were no significant associations of diabetes with utilization (OR, 0.95; 95% CI, 0.71-1.28) and persistence (OR, 1.09; 95% CI, 0.88-1.36) of endocrine therapy, timely initiation of radiotherapy (OR, 1.09; 95% CI, 0.86-1.38) and chemotherapy (OR, 1.09; 95% CI, 0.77-1.55), or completion of radiotherapy (OR, 1.25; 95% CI, 0.91-1.71). CONCLUSIONS AND RELEVANCE In this cohort study, preexisting diabetes was associated with subpar adjuvant therapies for breast cancer among low-income women. Improving diabetes management during cancer treatment is particularly important for low-income women with breast cancer who may have been disproportionately affected by diabetes and are likely to experience disparities in cancer treatment and outcomes.
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Affiliation(s)
- Bayu Begashaw Bekele
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Min Lian
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Chester Schmaltz
- Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia
| | | | - Pratibha Shrestha
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Ying Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, Missouri
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
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3
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Clasen SC, Shou H, Freedman G, Plastaras JP, Taunk NK, Kevin Teo BK, Smith AM, Demissei BG, Ky B. Early Cardiac Effects of Contemporary Radiation Therapy in Patients With Breast Cancer. Int J Radiat Oncol Biol Phys 2021; 109:1301-1310. [PMID: 33340602 PMCID: PMC11237872 DOI: 10.1016/j.ijrobp.2020.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/02/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To characterize the early changes in echocardiographically derived measures of cardiac function with contemporary radiation therapy (RT) in breast cancer and to determine the associations with radiation dose-volume metrics, including mean heart dose (MHD). METHODS AND MATERIALS In a prospective longitudinal cohort study of 86 patients with breast cancer treated with photon or proton thoracic RT, clinical and echocardiographic data were assessed at 3 time points: within 4 weeks before RT initiation (T0), within 3 days before 6 weeks after the end of RT (T1), and 5 to 9 months after RT completion (T2). Associations between MHD and echocardiographically derived measures of cardiac function were assessed using generalized estimating equations to define the acute (T0 to T1) and subacute (T0 to T2) changes in cardiac function. RESULTS The median estimates of MHD were 139 cGy (interquartile range, 99-249 cGy). In evaluating the acute changes in left ventricular ejection fraction (LVEF) from T0 to T1, and accounting for the time from RT, age, race, preexisting cardiovascular disease, and an interaction term with anthracycline or trastuzumab exposure and MHD, there was a modest decrease in LVEF of borderline significance (0.22%; 95% confidence interval [CI], -0.44% to 0.01%; P = .06) per 30-day interval for every 100 cGy increase of MHD. Similarly, there was a modest worsening in longitudinal strain (0.19%; 95% CI, -0.01% to 0.39%; P = .06) per 30-day interval for each 100 cGy increase in MHD. We did not find significant associations between MHD and changes in circumferential strain or diastolic function. CONCLUSIONS With modern radiation planning techniques, there are modest subclinical changes in measures of cardiac function in the short-term. Longer-term follow-up studies are needed to determine whether these early changes are associated with the development of overt cardiac disease.
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Affiliation(s)
- Suparna C Clasen
- Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Haochang Shou
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary Freedman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Plastaras
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neil K Taunk
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda M Smith
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Biniyam G Demissei
- Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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4
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Chang NT, Chang YH, Huang YT, Chen SC. Factors Associated with Refusal or Discontinuation of Treatment in Patients with Bladder Cancer: A Cohort Population-Based Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020618. [PMID: 33450864 PMCID: PMC7828302 DOI: 10.3390/ijerph18020618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
Cancer treatment causes adverse effects that lead to refusal or discontinuation of treatment. The purposes of this study were to identify 1) the factors associated with and 2) the reasons for refusing and discontinuing treatment in patients with bladder cancer (BC). We conducted a retrospective cohort study in patients diagnosed with BC in Taiwan from 1 January 2014 to 30 June 2019 using a linked cancer registry database. Of the 1247 BC patients in the study cohort, 2.1% reported refusing treatment. Patients with less education and those diagnosed at cancer stage II-IV were more likely to refuse treatment. The major reason for refusing treatment was "patient or the family considered patient's poor physical condition (chronic disease or unstable systemic disease), difficulty in enduring any condition likely to cause physical discomfort from disease treatment". A total of 4.3% of BC patients reported discontinuing treatment. Patients not living in the northern region of Taiwan and those diagnosed at cancer stage II-IV were more likely to terminate treatment before completion. The major reason given for discontinuing treatment was inconvenient transportation. Sufficient social resources and supportive care can help BC patients cope with the physical and psychological burden of treatment.
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Affiliation(s)
- Nai-Tan Chang
- Department of Nursing, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei Municipal Tucheng Hospital Chang Gung Memorial Hospital, New Taipei 236, Taiwan;
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
| | - Shu-Ching Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- School of Nursing and Geriatric and Long-Term Care Research Center, College of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan
- Department of Radiation Oncology and Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- Correspondence:
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Cao KI, Salviat F, Laki F, Falcou MC, Carton M, Poortmans P, Fourquet A, Kirova YM. Outcomes of postoperative radiation therapy for breast cancer in older women according to age and comorbidity status: An observational retrospective study in 752 patients. J Geriatr Oncol 2018. [DOI: 10.1016/j.jgo.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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6
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Wong ML, McMurry TL, Schumacher JR, Hu CY, Stukenborg GJ, Francescatti AB, Greenberg CC, Chang GJ, McKellar DP, Walter LC, Kozower BD. Comorbidity Assessment in the National Cancer Database for Patients With Surgically Resected Breast, Colorectal, or Lung Cancer (AFT-01, -02, -03). J Oncol Pract 2018; 14:e631-e643. [PMID: 30207852 DOI: 10.1200/jop.18.00175] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Accurate comorbidity measurement is critical for cancer research. We evaluated comorbidity assessment in the National Cancer Database (NCDB), which uses a code-based Charlson-Deyo Comorbidity Index (CCI), and compared its prognostic performance with a chart-based CCI and individual comorbidities in a national sample of patients with breast, colorectal, or lung cancer. PATIENTS AND METHODS Through an NCDB Special Study, cancer registrars re-abstracted perioperative comorbidities for 11,243 patients with stage II to III breast cancer, 10,880 with stage I to III colorectal cancer, and 9,640 with stage I to III lung cancer treated with definitive surgical resection in 2006-2007. For each cancer type, we compared the prognostic performance of the NCDB code-based CCI (categorical: 0 or missing data, 1, 2+), Special Study chart-based CCI (continuous), and 18 individual comorbidities in three separate Cox proportional hazards models for postoperative 5-year overall survival. RESULTS Comorbidity was highest among patients with lung cancer (13.2% NCDB CCI 2+) and lowest among patients with breast cancer (2.8% NCDB CCI 2+). Agreement between the NCDB and Special Study CCI was highest for breast cancer (rank correlation, 0.50) and lowest for lung cancer (rank correlation, 0.40). The NCDB CCI underestimated comorbidity for 19.1%, 29.3%, and 36.2% of patients with breast, colorectal, and lung cancer, respectively. Within each cancer type, the prognostic performance of the NCDB CCI, Special Study CCI, and individual comorbidities to predict postoperative 5-year overall survival was similar. CONCLUSION The NCDB underestimated comorbidity in patients with surgically resected breast, colorectal, or lung cancer, partly because the NCDB codes missing data as CCI 0. However, despite underestimation of comorbidity, the NCDB CCI was similar to the more complete measures of comorbidity in the Special Study in predicting overall survival.
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Affiliation(s)
- Melisa L Wong
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Timothy L McMurry
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Jessica R Schumacher
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Chung-Yuan Hu
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - George J Stukenborg
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Amanda B Francescatti
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Caprice C Greenberg
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - George J Chang
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Daniel P McKellar
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Louise C Walter
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
| | - Benjamin D Kozower
- University of California San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, CA; University of Virginia Health System, Charlottesville, VA; University of Wisconsin, Madison, WI; The University of Texas MD Anderson Cancer Center, Houston, TX; American College of Surgeons, Chicago, IL; and Washington University, St. Louis, MO
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7
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Stracci F, Bianconi F, Lupi C, Margaritelli M, Gili A, Aristei C. Spatial barriers impact upon appropriate delivery of radiotherapy in breast cancer patients. Cancer Med 2018; 7:370-379. [PMID: 29356463 PMCID: PMC5806099 DOI: 10.1002/cam4.1304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/25/2017] [Accepted: 11/28/2017] [Indexed: 01/21/2023] Open
Abstract
Radiotherapy (RT) is the standard treatment for breast cancer patients after conserving surgery or mastectomy when patients are at high risk of relapse. Major obstacles to appropriate RT delivery are journey times. Since studies on access to RT were carried out mostly in large countries, this study investigated factors in an Italian region and the influence of RT delivery on survival. A total of 4735 female candidates for RT were included in the study. A geographic information system calculated journey times from patients' homes and surgery hospitals to RT centers. Logistic regression analyzed the influence of journey times, socioeconomic status, and other factors on RT delivery. Survival probabilities and excess mortality were assessed in 4364 propensity score-matched patients. Journey times of 40 min or less from residence and from surgery hospital to RT center played a major role in access to RT. A large survival difference emerged between treated and untreated breast cancer patients. The excess mortality for untreated patients compared with propensity score-matched women receiving RT was 3.1 (95% CI: 2.2-4.3). Expansion of RT facilities during the 11-year study period improved RT delivery and outcomes by increasing availability but mainly by shortening journey times.
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Affiliation(s)
- Fabrizio Stracci
- Department of Experimental MedicineSection of Public HealthUniversity of PerugiaPerugiaItaly
- Umbria Cancer RegistryPerugiaItaly
| | | | | | | | | | - Cynthia Aristei
- Department of Surgery and Biomedical SciencesSection of Radiation OncologyUniversity of Perugia and Perugia General HospitalPerugiaItaly
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8
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Dominici LS, King TA. How do age and molecular subtypes impact surgical decisions? BREAST CANCER MANAGEMENT 2018. [DOI: 10.2217/bmt-2017-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tumor molecular subtype and patient age are the predominant drivers of recommendations for systemic therapy in patients with breast cancer. Yet, the impact of these factors on surgical decision-making remains controversial. Younger women often receive the most extensive surgical therapy despite a lack of evidence that bigger surgery translates into better outcomes. In contrast, among older women, there is a desire to minimize local therapy and its associated morbidity. Here, we review contemporary data highlighting the relationship between patient age and breast cancer molecular subtype, and local therapy outcomes. Our perspective is that tumor biology, rather than age, should be the driving factor in determining appropriate local therapy for breast cancer.
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Affiliation(s)
- Laura S Dominici
- Surgical Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, MA 02215, USA
- Department of Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Tari A King
- Surgical Oncology, Dana-Farber/Brigham & Women's Cancer Center, Boston, MA 02215, USA
- Department of Surgery, Brigham & Women's Hospital, Boston, MA 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
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9
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Chiang TY, Wang CH, Lin YF, You JF, Chen JS, Chen SC. Colorectal cancer in Taiwan: A case-control retrospective analysis of the impact of a case management programme on refusal and discontinuation of treatment. J Adv Nurs 2017; 74:395-406. [DOI: 10.1111/jan.13443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Ting-Yu Chiang
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Graduate Institute of Nursing; College of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
| | - Chao-Hui Wang
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Nursing; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Yu-Fen Lin
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - Jeng-Fu You
- Division of Colorectal Surgery; Department of Surgery; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Jinn-Shiun Chen
- Division of Colorectal Surgery; Department of Surgery; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Department of Medicine; College of Medicine; Chang Gung University; Taoyuan Taiwan
| | - Shu-Ching Chen
- Department of Nursing; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
- Graduate Institute of Nursing; College of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
- Department of Nursing; College of Nursing; Chang Gung University of Science and Technology; Taoyuan Taiwan
- Department of Radiation Oncology; Proton and Radiation Therapy Center; Chang Gung Medical Foundation; Linkou Chang Gung Memorial Hospital; Taoyuan Taiwan
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10
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Dean LT, Moss SL, McCarthy AM, Armstrong K. Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations. Cancer Epidemiol Biomarkers Prev 2017; 26:1745-1752. [PMID: 28971987 DOI: 10.1158/1055-9965.epi-17-0479] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/07/2017] [Accepted: 09/18/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Adjuvant therapy after breast cancer surgery decreases recurrence and increases survival, yet not all women receive and complete it. Previous research has suggested that distrust in medical institutions plays a role in who initiates adjuvant treatment, but has not assessed treatment completion, nor the potential mediating role of physician distrust.Methods: Women listed in Pennsylvania and Florida cancer registries, who were under the age of 65 when diagnosed with localized invasive breast cancer between 2005 and 2007, were surveyed by mail in 2007 to 2009. Survey participants self-reported demographics, cancer stage and treatments, treatment discordance (as defined by not following their surgeon or oncologist treatment recommendation), healthcare system distrust, and physician trust. Age and cancer stage were verified against cancer registry records. Logistic regression assessed the relationship between highest and lowest tertiles of healthcare system distrust and the dichotomous outcome of treatment discordance, controlling for demographics and clinical treatment factors, and testing for mediation by physician trust.Results: Of the 2,754 participants, 30.2% (n = 832) reported not pursing at least one recommended treatment. The mean age was 52. Patients in the highest tertile of healthcare system distrust were 22% more likely to report treatment discordance than the lowest tertile; physician trust did not mediate the association between healthcare system distrust and treatment discordance.Conclusions: Healthcare system distrust is positively associated with treatment discordance, defined as failure to initiate or complete physician-recommended adjuvant treatment after breast cancer.Impact: Interventions should test whether or not resolving institutional distrust reduces treatment discordance. Cancer Epidemiol Biomarkers Prev; 26(12); 1745-52. ©2017 AACR.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland. .,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Shadiya L Moss
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Anne Marie McCarthy
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katrina Armstrong
- Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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11
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Trends in adjuvant therapies after breast-conserving surgery for hormone receptor-positive ductal carcinoma in situ: findings from the National Cancer Database, 2004-2013. Breast Cancer Res Treat 2017; 166:583-592. [PMID: 28776282 DOI: 10.1007/s10549-017-4436-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Breast-conserving surgery (BCS) followed by radiotherapy (RT) with or without endocrine therapy (ET) is a standard treatment option for ductal carcinoma in situ (DCIS). We sought to investigate national patterns in the use of adjuvant therapy after BCS for hormone receptor (HR)-positive DCIS over time. PATIENTS AND METHODS Using data from the National Cancer Data Base, we identified patients diagnosed with DCIS and treated with BCS between 2004 and 2013. Multivariable logistic regression was used to estimate the odds of adjuvant therapy use controlling for clinicopathologic demographic and facility-level characteristics. RESULTS We identified 66,079 patients who underwent BCS for DCIS. Overall, 21% received no adjuvant treatment, 71% received RT, 48% received ET, and 38% received the combination therapy. In adjusted analyses among the patients with HR-positive DCIS (n = 50,147), the administration of RT decreased (odds ratio [OR] 0.86, 95% CI 0.77-0.97), while the use of ET increased (OR 1.5, 95% CI 1.4-1.6) in 2013 compared to 2004. Young patients, elderly patients, positive margin status, and Medicare insurance were associated with lower use of both RT and ET. We observed both clinicopathologic and geographic variation in the use of adjuvant therapies. In the lowest risk subgroup, the use of RT decreased from 57% in 2004 to 48% in 2013 (OR 0.64, 95% CI 0.45-0.89). CONCLUSION Our study suggests a shift in patterns of care for DCIS that is impacted by both clinicopathologic and demographic factors, with the use of RT decreasing and the use of ET increasing in HR-positive DCIS patients. Current trials are designed to address the possible over-treatment of low-risk DCIS.
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