Michael J Raphael1,2, Gary Ko2, Christopher M Booth2,3,4, Susan B Brogly4,5, Wenbin Li4, Maria Kalyvas2,6, Timothy P Hanna2,4,6, Sunil V Patel2,4,5. 1. Sunnybrook Health Sciences Centre, Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada. 3. Division of Medical Oncology, Department of Oncology, Queen's University, Kingston, Ontario, Canada. 4. International Credential Evaluation Service, Queen's, Kingston, Ontario, Canada. 5. Department of Surgery, Queen's University, Kingston, Ontario, Canada. 6. Division of Radiation Oncology, Department of Oncology, Queen's University, Kingston, Ontario, Canada.
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 Participants: In 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 Measures: Treatment 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. Results: Overall, 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 (RR, 1.54; 95% CI, 1.03, 2.31), overall death (hazard ratio [HR], 1.54; 95% CI, 1.23-1.92), cancer-specific death (HR, 1.59; 95% CI, 1.14-2.22), and colostomy or death (HR, 1.80; 95% CI: 1.10-2.93). Treatment interruptions longer than 7 days were not associated with death. Conclusions and Relevance: Many patients undergoing curative-intent chemoradiation for anal cancer experienced treatment interruption or noncompletion. Quality improvement initiatives to optimize treatment continuity and completion are needed.
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 Participants: In 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 Measures: Treatment 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. Results: Overall, 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 (RR, 1.54; 95% CI, 1.03, 2.31), overall death (hazard ratio [HR], 1.54; 95% CI, 1.23-1.92), cancer-specific death (HR, 1.59; 95% CI, 1.14-2.22), and colostomy or death (HR, 1.80; 95% CI: 1.10-2.93). Treatment interruptions longer than 7 days were not associated with death. Conclusions and Relevance: Many patients undergoing curative-intent chemoradiation for anal cancer experienced treatment interruption or noncompletion. Quality improvement initiatives to optimize treatment continuity and completion are needed.
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Prev Med Date: 2007-09-04 Impact factor: 4.018
Authors: H Bartelink; F Roelofsen; F Eschwege; P Rougier; J F Bosset; D G Gonzalez; D Peiffert; M van Glabbeke; M Pierart Journal: J Clin Oncol Date: 1997-05 Impact factor: 44.544
Authors: Lisa A Kachnic; Kathryn Winter; Robert J Myerson; Michael D Goodyear; John Willins; Jacqueline Esthappan; Michael G Haddock; Marvin Rotman; Parag J Parikh; Howard Safran; Christopher G Willett Journal: Int J Radiat Oncol Biol Phys Date: 2012-11-12 Impact factor: 7.038
Authors: Roger D James; Robert Glynne-Jones; Helen M Meadows; David Cunningham; Arthur Sun Myint; Mark P Saunders; Timothy Maughan; Alec McDonald; Sharadah Essapen; Martin Leslie; Stephen Falk; Charles Wilson; Simon Gollins; Rubina Begum; Jonathan Ledermann; Latha Kadalayil; David Sebag-Montefiore Journal: Lancet Oncol Date: 2013-04-09 Impact factor: 41.316
Authors: Carl J Nelson; Nataniel H Lester-Coll; Puyao C Li; Havaleh Gagne; Christopher J Anker; Matthew A Deeley; H James Wallace Journal: Adv Radiat Oncol Date: 2020-11-19
Authors: Nikhil V Kotha; Abhishek Kumar; Tyler J Nelson; Edmund M Qiao; Alex S Qian; Rohith S Voora; Rana R McKay; Tyler F Stewart; Brent S Rose Journal: Adv Radiat Oncol Date: 2021-10-25
Authors: Carl J Nelson; Emilie T Soisson; Puyao C Li; Nataniel H Lester-Coll; Havaleh Gagne; Matthew A Deeley; Christopher J Anker; Lori Ann Roy; H James Wallace Journal: Adv Radiat Oncol Date: 2022-06-18