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Factors associated with radiation therapy incompletion for patients with early-stage breast cancer

Breast Cancer Research and Treatment volume 155, pages 187–199 (2016)Cite this article

Abstract

Purpose

The purpose of the study was to examine factors associated with adjuvant radiation treatment (RT) incompletion for women with breast cancer within a large national cancer database.

Methods

We identified 394,334 women diagnosed with stage I–III breast cancer during 2004–2012 in the national cancer database who initiated adjuvant external beam adjuvant RT and examined the proportion of women not completing treatment. We used multivariable logistic regression to examine patient, clinical, and facility factors associated with RT incompletion for those who had breast-conserving surgery (BCS), defined as <15 fractions and <3990 centiGray [cGy] (accounting for adoption of hypofractionation), and mastectomy (PMRT, defined as <5000 cGy and <25 fractions), separately. We also examined RT incompletion after BCS using more traditional definitions of <25 fractions and <4500 cGy for diagnosis years ≤2010.

Results

Among the 319,003 women who underwent BCS and the 75,331 women who underwent mastectomy and initiated RT, 98.4 and 97.8 % completed radiation, respectively. In adjusted analyses, older age was associated with RT incompletion (odds ratio [O.R.] for age ≥80 = 2.53 for BCS-treated, 95 % confidence interval [CI] 2.19–2.92; O.R. for PMRT incompletion = 2.33, 95 % CI 1.84–2.96; both versus age <50). In addition, those with ≥2 comorbidities and lower-risk disease had higher odds of RT incompletion. After defining RT completion using more traditional definitions, 94.0 % completed treatment.

Conclusions

Reassuringly, we found a very low proportion of patients not completing RT, though we observed a higher likelihood for treatment incompletion in some sub-groups, most notably older women. Further studies should focus on reasons for treatment discontinuation in populations at risk for suboptimal treatment.

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Acknowledgments

The data used in the study are derived from a limited data set of the national cancer data base (NCDB). The authors acknowledge the efforts of the American College of Surgeons, the Commission on Cancer, and the American Cancer Society in the creation of the national cancer data base. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the authors.

Funding

American Cancer Society Intramural Research and Susan G. Komen for the Cure (RAF).

Disclosures

All authors declare that they have no conflict of interest.

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Affiliations

  1. Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Rachel A. Freedman & Rinaa S. Punglia

  2. American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, USA

    Stacey A. Fedewa, Chun Chieh Lin, Elizabeth M. Ward, Ahmedin Jemal & Helmneh M. Sineshaw

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  1. Rachel A. Freedman
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Correspondence to Rachel A. Freedman.

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Freedman, R.A., Fedewa, S.A., Punglia, R.S. et al. Factors associated with radiation therapy incompletion for patients with early-stage breast cancer. Breast Cancer Res Treat 155, 187–199 (2016). https://doi.org/10.1007/s10549-015-3660-4

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  • DOI: https://doi.org/10.1007/s10549-015-3660-4

Keywords

  • Breast cancer
  • Radiation
  • Incomplete treatment