Medical factors influencing decision making regarding radiation therapy for breast cancer

Dilaveri, Christina A.; Sandhu, Nicole P.; Neal, Lonzetta; Neben-Wittich, M.A.; Hieken, Tina J.; Bride, Marie Brid Mac; Wahner‐Roedler, Dietlind L.; Ghosh, Karthnik

doi:10.2147/ijwh.s71591

Cited by 6 publications

(4 citation statements)

References 60 publications

(72 reference statements)

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“…Restricted access to radiotherapy may explain why high proportions of women received mastectomy particularly in Estonia and Portugal, and may also explain why older women more often received mastectomy than younger women . Furthermore, several medical conditions contraindicate RT and in such cases mastectomy is reasonable.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Minicozzi

Eycken²,

Molinié

et al. 2018

Intl Journal of Cancer

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Survival for breast cancer (BC) is lower in eastern than northern/central Europe, and in older than younger women. We analysed how comorbidities at diagnosis affected whether selected standard treatments (STs) were given, across Europe and over time, also assessing consequences for survival/relapse. We analysed 7581 stage I/IIA cases diagnosed in 9 European countries in 2009-2013, and 4 STs: surgery; breast-conserving surgery plus radiotherapy (BCS + RT); reconstruction after mastectomy; and prompt treatment (≤6 weeks after diagnosis). Covariate-adjusted models estimated odds of receiving STs and risks of death/relapse, according to comorbidities. Pearson's R assessed correlations between odds and risks. The z-test assessed the significance of time-trends. Most women received surgery: 72% BCS; 24% mastectomy. Mastectomied patients were older with more comorbidities than BCS patients (p < 0.001). Women given breast reconstruction (25% of mastectomies) were younger with fewer comorbidities than those without reconstruction (p < 0.001). Women treated promptly (45%) were younger than those treated later (p = 0.001), and more often without comorbidities (p < 0.001). Receiving surgery/BCS + RT correlated strongly (R = −0.9), but prompt treatment weakly (R = −0.01/−0.02), with reduced death/relapse risks. The proportion receiving BCS + RT increased significantly (p < 0.001) with time in most countries. This appears to be the first analysis of the influence of comorbidities on receiving STs, and of consequences for outcomes. Increase in BCS + RT with time is encouraging. Although women without comorbidities usually received STs, elderly patients often received non-standard less prompt treatments, irrespective of comorbidities, with increased risk of mortality/relapse. All women, particularly the elderly, should receive ST wherever possible to maximise the benefits of modern evidence-based treatments.

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Section: Discussionmentioning

confidence: 99%

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Minicozzi

Eycken²,

Molinié

et al. 2018

Intl Journal of Cancer

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“…In this observational study, radiotherapy was not randomized and unmeasured factors associated with receipt of radiotherapy and risk of second cancers could lead to residual confounding. The primary contraindications to radiotherapy for breast cancer are prior radiotherapy, pre-existing heart conditions and genetic predispositions to cancer [40]. These factors are likely associated with a higher risk of cancer and thus uncontrolled confounding would result in underestimation of the radiotherapy-related risk.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for ductal carcinoma in situ and risk of second non-breast cancers

Withrow

Morton

Curtis

et al. 2017

Breast Cancer Res Treat

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Radiotherapy was associated with an increased risk of second non-breast cancers. The specific excess of cancers at sites likely in/near the radiotherapy field suggests the findings are unlikely due exclusively to confounding, but further research into factors related to receipt of radiotherapy is needed. Our risk estimates can be used to help assess the balance of the risks and benefits of radiotherapy for DCIS and to inform clinical practice.

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“…The potential differential utilization of cancer therapies was not examined in our study but could also be related to the findings. For instance, patients with RA may be less likely to receive certain therapies, such as radiotherapy , because of fear of complications or may discontinue therapy early. Likewise, the effect of immunomodulatory agents used in the treatment of RA could also interfere with tumor immunity and possibly result in worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Rheumatoid Arthritis on the Mortality of Elderly Patients Who Develop Cancer: A Population‐Based Study

Nayak

Luo

Elting

et al. 2016

Arthritis Care & Research

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Objective Comorbidity among cancer patients poses additional risks for mortality. The possible impact of rheumatoid arthritis (RA) on cancer patient survival is unclear. Our objective was to examine survival among elderly patients with RA who develop cancer. Methods Patients diagnosed with breast, prostate, colorectal, or lung cancer between 2001 and 2010 were identified from the Texas Cancer Registry and Medicare–linked databases. The cohort was categorized into 3 groups according to the number of claims patients had with a diagnosis of RA in the year prior to the cancer diagnosis: 2‐RA (patients with ≥2 claims), 1‐RA (1 claim), and no claims. Overall survival was estimated for these groups and for each cancer, using Cox proportional hazards models adjusting for covariates. Results The cohort included 139,097 patients with cancer (35,026 breast, 43,181 prostate, 31,103 colorectal, and 29,787 lung); 1.7% had 1 RA claim, and 1.1% had 2 or more. Adjusted hazard ratios for patients in the 2‐RA group were 1.41 (95% confidence interval [95% CI] 1.21–1.65) for breast and 1.53 (95% CI 1.26–1.85) for prostate. No significant differences were observed for those with colorectal or lung cancer. Conclusion Mortality was increased by 40% and 50%, respectively, in elderly patients with RA who developed breast or prostate cancer, after controlling for other comorbidities. This association was not seen in cancers with shorter survival time (colorectal or lung). Research is needed to determine whether the increased risk is related to comorbid burden or to differential utilization of cancer or rheumatoid therapies in patients with both diseases.

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Medical factors influencing decision making regarding radiation therapy for breast cancer

Cited by 6 publications

References 60 publications

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Comorbidities, age and period of diagnosis influence treatment and outcomes in early breast cancer

Radiotherapy for ductal carcinoma in situ and risk of second non-breast cancers

Impact of Rheumatoid Arthritis on the Mortality of Elderly Patients Who Develop Cancer: A Population‐Based Study

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