Factors Associated With Chemoradiation Therapy Interruption and Noncompletion Among Patients With Squamous Cell Anal Carcinoma

Abstract

IMPORTANCE Definitive chemoradiation for anal cancer is effective but may be associated with toxic effects, and some patients may not be able to complete the planned treatment. Identifying factors associated with treatment interruption and noncompletion is important to target quality improvement efforts. OBJECTIVE To identify rates of chemoradiation treatment interruption or noncompletion and factors associated with this among patients with anal cancer treated in routine clinical practice. DESIGN, SETTING, AND PARTICIPANTSIn this population-based, retrospective cohort study, the Ontario Cancer Registry was used to identify all incident cases of squamous cell anal cancer treated with curative-intent radiation from 2007 to 2015 in Ontario, Canada. Final analysis of data was performed on August 9, 2019.EXPOSURES Curative-intent radiation therapy. MAIN OUTCOMES AND MEASURESTreatment interruption was defined as more than 7 days between fractions of radiation. Radiation completion was defined as receipt of 45 Gy or more and 25 fractions of radiation. Chemoradiation completion was defined as radiation completion and 2 doses of combination chemotherapy. Associations between patient factors and treatment interruption and noncompletion were estimated with log-binomial models. Cox proportional hazard models were used to estimate the association of treatment interruption or noncompletion with all-cause death, cancer-specific death, and the combined outcome of colostomy or death. RESULTSOverall, 1125 patients with stage I-III anal cancer were treated with curative-intent radiation. Treatment interruptions occurred in 262 (23%). Radiation and chemoradiation noncompletion occurred in 199 (18%) and 280 (25%), respectively. No associations were found to correlate with an increased risk of treatment interruption. Patients older than 70 years were less likely to complete chemoradiation (risk ratio [RR], 0.60; 95% CI, 0.52-0.70), compared with those younger than 50 years. Patients with a higher number of comorbidities were also less likely to complete chemoradiation (RR, 0.70; 95% CI, 0.51-0.95). Patients who did not complete chemoradiation had a higher risk of requiring salvage abdominoperineal resection (

<p>Relationship of Adherence to Cervical Cancer Treatment Guideline Towards Patients’ Five-year Survival: Systematic Review of Follow-up Trials</p>

“…15 This was confirmed by Raphael et al who stated the rate of 0.70 times (95%CI: 0.51-0.95) on the same aspect and stated that patients aged more than 70 years will only get chance of getting guideline-adherent therapy 0.60 times (95%CI: 0.52-0.70). 16 There are differences of adherence statement about adjuvant radiation postsurgery in certain early stage cervical cancers. [13][14][15] Adjuvant radiation is given to cervical cancer with some risk factors.…”

“…Increased dosage could induce chemoradiation toxicity, thus therapy could not be conducted without advanced modality such as three-dimension brachytherapy and implant. 16 Some solutions that can be used to overcome the problems mentioned above include evaluating patient response post 20 fractions of external beam radiotherapy in order to evaluate preparedness of brachytherapy, consider systematic transition from two-to three-dimensional brachytherapy. 8,20 Patient's Outcome Difference by Guideline Adherence…”

L’expertise médicale au temps des pandémies : l’exemple des cancers

“…La poursuite du traitement est impossible en raison du risque de contamination des autres patientes, du personnel hospitalier, médical et para médical, du contact avec les personnes qui les transportent [3] , [4] , [5] , [6] , [7] .…”

The influence of red blood cell transfusions on the progression-free survival of patients with localized squamous cell carcinoma of the anus treated with definitive chemoradiation

“…Unfortunately, we could not retrieve information of ChRT dose-intensity, an important known prognostic factor for progression. 23 Our study has some relevant limitations. As a retrospective analysis, it was not possible to prove causality between RBCT and SCCA progression after ChRT.…”