Patient views and correlates of radiotherapy omission in a population‐based sample of older women with favorable‐prognosis breast cancer

Shumway, Dean A.; Griffith, Kent A.; Hawley, Sarah T.; Wallner, Lauren P.; Ward, Kevin C.; Hamilton, Ann S.; Morrow, Monica; Jagsi, Reshma

doi:10.1002/cncr.31378

Cited by 16 publications

(11 citation statements)

References 38 publications

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“…Advice from the treating physician plays a significant role. 17,27 In the study by Jagsi et al, which surveyed 2260 patients regarding radiation use, level of surgeon involvement was significantly associated with receipt of radiation. However, only 10 per cent of surgeons recommended no radiation in patients who met the CALGB 9343 criteria.…”

Section: Discussionmentioning

confidence: 99%

“…In a follow-up survey, Jagsi showed that 40 per cent of surgeons and 20 per cent of radiation oncologists felt omitting radiation in CALGB 9343 eligible patients was substandard, and a significant proportion of both groups incorrectly associated radiation with improved survival and overestimated local recurrence risks. 27 Fortunately, clinical pathways show promise in standardizing evidence-based or guidelineconcordant radiation treatment plans. 28…”

Section: Discussionmentioning

confidence: 99%

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From Evidence to Practice: Are Low-Risk Breast Cancer Patients still Enduring Unnecessary Costs of Radiation?

Thornhill

Chang

Selleck

et al. 2019

The American Surgeon™

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Radiation is routinely recommended after conservative surgery for breast cancer, despite longstanding Level I evidence showing no survival benefit for elderly patients with favorable disease using endocrine therapy. We sought to evaluate radiation use and costs in patients eligible for omission of radiation. A retrospective single-institution review from 2005 to 2017 was performed of women aged ≥70 years, with cT1N0M0, who were ER/PR positive and HER-2 negative, and receiving breast-conserving surgery. Patient, tumor, and treatment characteristics were compared by use of radiation. Cost estimates used Medicare's 2019 fee schedule. Of 84 patients meeting the study criteria, 72.6 per cent received radiation and 56 per cent received endocrine therapy, with four recurrences (4.9% radiated and 4.4% not radiated, P = 0.9). Early and late grade I radiation toxicities occurred in 67.2 per cent and 26.2 per cent of radiated patients, respectively. Younger age ( P = 0.01), receipt of endocrine therapy ( P < 0.0001), and axillary surgery ( P < 0.0001) were significantly associated with radiation use. There were no significant differences in radiation use based on race/ethnicity, language, comorbidities, BMI, or pathologic tumor size. Estimated total radiation cost was $646,426. Radiation remains overused and endocrine therapy, underused in breast cancer patients eligible to avoid radiation. As gatekeepers for radiation oncology referrals, surgeons can diminish both physical and financial costs of radiation in eligible patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

From Evidence to Practice: Are Low-Risk Breast Cancer Patients still Enduring Unnecessary Costs of Radiation?

Thornhill

Chang

Selleck

et al. 2019

The American Surgeon™

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“…In the United States, approximately two‐thirds of women eligible to forgo radiation receive it, calling into question how patients make treatment decisions. While previous studies suggest that patients overestimate their risk of recurrence, data demonstrating an association between the perceived risk of recurrence and the receipt of adjuvant radiotherapy is limited . It is unclear whether the perceived radiotherapy benefit (the difference in risk of recurrence with vs without radiotherapy) is associated with receipt of treatment.…”

Section: Introductionmentioning

confidence: 99%

“…of adjuvant radiotherapy is limited. 5,6 It is unclear whether the perceived radiotherapy benefit (the difference in risk of recurrence with vs without radiotherapy) is associated with receipt of treatment.…”

mentioning

confidence: 99%

Association between perceived benefits and receipt of radiotherapy among older breast cancer patients

et al. 2019

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While radiotherapy can be safely omitted in many older women with early‐stage breast cancer after lumpectomy, approximately two‐thirds of eligible women still undergo this treatment. We surveyed 63 older women with stage I (T1N0M0), estrogen‐receptor‐positive breast cancer who underwent lumpectomy, and were considering/receiving radiotherapy. Participants perceived that radiotherapy would reduce their 10‐year risk of local recurrence by an average of 18.7%, which is significantly higher than the 8% risk reduction reported in literature. Multivariate analyses demonstrated that participants who reported a large perceived benefit were significantly more likely to undergo radiotherapy treatment (odds ratio 10.34; 95% confidence interval: 1.66‐66.35).

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“…Many also overestimated the local‐regional recurrence rate, and 29% of surgeons and 10% of radiation oncologists believed the use of RT improved survival in this population. In a similar type survey of 999 patients, many also overestimated the risk of disease recurrence …”

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confidence: 99%

Changing the practice patterns of delivery of adjuvant radiation in the elderly with low‐risk breast cancer: It’s harder to do than you think!

McCormick

2020

Breast J

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Patient views and correlates of radiotherapy omission in a population‐based sample of older women with favorable‐prognosis breast cancer

Cited by 16 publications

References 38 publications

From Evidence to Practice: Are Low-Risk Breast Cancer Patients still Enduring Unnecessary Costs of Radiation?

From Evidence to Practice: Are Low-Risk Breast Cancer Patients still Enduring Unnecessary Costs of Radiation?

Association between perceived benefits and receipt of radiotherapy among older breast cancer patients

Changing the practice patterns of delivery of adjuvant radiation in the elderly with low‐risk breast cancer: It’s harder to do than you think!

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