Lauren J Taylor1, Jennifer S Steiman2, Bethany Anderson3,4, Jessica R Schumacher1, Lee G Wilke1,4, Caprice C Greenberg1,4, Heather B Neuman5,6,7. 1. Department of Surgery, University of Wisconsin, Madison, WI, USA. 2. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 3. Department of Human Oncology, University of Wisconsin, Madison, WI, USA. 4. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA. 5. Department of Surgery, University of Wisconsin, Madison, WI, USA. neuman@surgery.wisc.edu. 6. Carbone Cancer Center, University of Wisconsin, Madison, WI, USA. neuman@surgery.wisc.edu. 7. Clinical Science Center, 600 Highland Avenue, K6/142, Box 7375, Madison, WI, 53792, USA. neuman@surgery.wisc.edu.
Abstract
PURPOSE: Randomized controlled trials demonstrate that omission of radiation therapy (RT) in older women with early-stage cancer undergoing breast conserving surgery (BCS) is an "acceptable choice." Despite this, high RT rates have been reported. The objective was to evaluate the impact of patient- and system-level factors on RT rates in a contemporary cohort. METHODS: Through the National Cancer Data Base, we identified women with clinical stage I estrogen receptor-positive breast cancer who underwent BCS (n = 84,214). Multivariable logistic regression identified patient, tumor, and system-level factors associated with RT. Joinpoint regression analysis calculated trends in RT use over time stratified by age and facility-type, reporting annual percent change (APC). RESULTS: RT rates decreased from 2004 (77.2%) to 2015 (64.3%). The decline occurred earliest and was most pronounced in older women treated at academic facilities. At academic facilities, the APC was - 5.6 (95% CI - 8.6, - 2.4) after 2009 for women aged > 85 years, - 6.4 (95% CI - 9.0, - 3.8) after 2010 for women aged 80 - < 85 years, - 3.7 (95% CI - 5.6, - 1.9) after 2009 for women aged 75 - < 80, and - 2.4 (95% CI, - 3.1, - 1.6) after 2009 for women aged 70 - < 75. In contrast, at community facilities rates of RT declined later (2011, 2012, and 2013 for age groups 70-74, 75-79, and 80-84 years). CONCLUSIONS: RT rates for older women with early-stage breast cancer are declining with patient-level variation based on factors related to life expectancy and locoregional recurrence. Facility-level variation suggests opportunities to improve care delivery by focusing on barriers to de-implementation of routine use of RT.
PURPOSE: Randomized controlled trials demonstrate that omission of radiation therapy (RT) in older women with early-stage cancer undergoing breast conserving surgery (BCS) is an "acceptable choice." Despite this, high RT rates have been reported. The objective was to evaluate the impact of patient- and system-level factors on RT rates in a contemporary cohort. METHODS: Through the National Cancer Data Base, we identified women with clinical stage I estrogen receptor-positive breast cancer who underwent BCS (n = 84,214). Multivariable logistic regression identified patient, tumor, and system-level factors associated with RT. Joinpoint regression analysis calculated trends in RT use over time stratified by age and facility-type, reporting annual percent change (APC). RESULTS: RT rates decreased from 2004 (77.2%) to 2015 (64.3%). The decline occurred earliest and was most pronounced in older women treated at academic facilities. At academic facilities, the APC was - 5.6 (95% CI - 8.6, - 2.4) after 2009 for women aged > 85 years, - 6.4 (95% CI - 9.0, - 3.8) after 2010 for women aged 80 - < 85 years, - 3.7 (95% CI - 5.6, - 1.9) after 2009 for women aged 75 - < 80, and - 2.4 (95% CI, - 3.1, - 1.6) after 2009 for women aged 70 - < 75. In contrast, at community facilities rates of RT declined later (2011, 2012, and 2013 for age groups 70-74, 75-79, and 80-84 years). CONCLUSIONS: RT rates for older women with early-stage breast cancer are declining with patient-level variation based on factors related to life expectancy and locoregional recurrence. Facility-level variation suggests opportunities to improve care delivery by focusing on barriers to de-implementation of routine use of RT.
Entities:
Keywords:
Breast cancer; Breast conserving therapy; De-escalation; Elderly; Lumpectomy; Radiation
Authors: M Clarke; R Collins; S Darby; C Davies; P Elphinstone; V Evans; J Godwin; R Gray; C Hicks; S James; E MacKinnon; P McGale; T McHugh; R Peto; C Taylor; Y Wang Journal: Lancet Date: 2005-12-17 Impact factor: 79.321
Authors: Charles E Rutter; Nataniel H Lester-Coll; Brandon R Mancini; Christopher D Corso; Henry S Park; Debra N Yeboa; Cary P Gross; Suzanne B Evans Journal: Cancer Date: 2015-03-24 Impact factor: 6.860
Authors: Ian H Kunkler; Linda J Williams; Wilma J L Jack; David A Cameron; J Michael Dixon Journal: Lancet Oncol Date: 2015-01-28 Impact factor: 41.316
Authors: Beryl McCormick; Rebecca A Ottesen; Melissa E Hughes; Sara H Javid; Seema A Khan; Joanne Mortimer; Joyce C Niland; Jane C Weeks; Stephen B Edge Journal: J Am Coll Surg Date: 2014-06-06 Impact factor: 6.113
Authors: Richard Pötter; Michael Gnant; Werner Kwasny; Christoph Tausch; Leonore Handl-Zeller; Brigitte Pakisch; Susanne Taucher; Josef Hammer; Gero Luschin-Ebengreuth; Marianne Schmid; Felix Sedlmayer; Michael Stierer; Georg Reiner; Karin Kapp; Friedrich Hofbauer; Andrea Rottenfusser; Sabine Pöstlberger; Karin Haider; Wolfgang Draxler; Raimund Jakesz Journal: Int J Radiat Oncol Biol Phys Date: 2007-03-23 Impact factor: 7.038
Authors: Brooke C Bredbeck; Nicole M Mott; Ton Wang; Brandy R Sinco; Tasha M Hughes; Hari Nathan; Lesly A Dossett Journal: Ann Surg Oncol Date: 2022-04-05 Impact factor: 5.344
Authors: Lesly A Dossett; Nicole M Mott; Brooke C Bredbeck; Ton Wang; Chad Tc Jobin; Tasha M Hughes; Sarah T Hawley; Brian J Zikmund-Fisher Journal: J Surg Res Date: 2021-11-19 Impact factor: 2.192
Authors: Luis Chang-Azancot; Pedro Abizanda; María Gijón; Nitzan Kenig; Manuel Campello; Jessica Juez; Antonio Talaya; Gregorio Gómez-Bajo; Javier Montón; Rodrigo Sánchez-Bayona Journal: Aesthetic Plast Surg Date: 2022-08-04 Impact factor: 2.708
Authors: Ton Wang; Alison Baskin; Jacquelyn Miller; Allan Metz; Niki Matusko; Tasha Hughes; Michael Sabel; Jacqueline S Jeruss; Lesly A Dossett Journal: Ann Surg Oncol Date: 2020-07-10 Impact factor: 5.344
Authors: Alison S Baskin; Ton Wang; Nicole M Mott; Sarah T Hawley; Reshma Jagsi; Lesly A Dossett Journal: Ann Surg Oncol Date: 2020-07-30 Impact factor: 5.344
Authors: Ton Wang; Nicole Mott; Jacquelyn Miller; Nicholas L Berlin; Sarah Hawley; Reshma Jagsi; Lesly A Dossett Journal: JAMA Netw Open Date: 2020-09-01