Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center

Ohri, Nitin; Rapkin, Bruce D.; Guha, Chandan; Kalnicki, Shalom; Garg, Madhur

doi:10.1016/j.ijrobp.2016.01.043

Cited by 81 publications

(76 citation statements)

References 24 publications

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“…Concurrent chemotherapy can both exacerbate acute radiotherapy toxicities and introduce new side effects 1,2 . Acute treatment toxicities frequently lead to treatment interruptions and/or hospitalizations 3 , which detract from treatment efficacy 4,5 and place burdens on the health care system 6,7 . In this pilot study, we tested the feasibility of using commercially-available fitness trackers for assessing patients with head and neck, lung, or gastrointestinal cancers throughout the course of concurrent chemoradiotherapy.…”

Section: Introductionmentioning

confidence: 99%

Continuous Activity Monitoring During Concurrent Chemoradiotherapy

Ohri

Kabarriti

Bodner

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Background Wearable activity monitors are widely available and marketed as fitness trackers. We performed a prospective trial testing the feasibility and utility of acquiring activity data as a measure of health status during concurrent chemoradiotherapy. Methods Ambulatory patients who were planned for treatment with concurrent chemoradiotherapy with curative intent for cancers of the head and neck, lung, or gastrointestinal (GI) tract were provided with activity monitors prior to treatment initiation. Patients were asked to wear the devices continuously throughout the radiotherapy course. Step count data were downloaded at weekly during radiotherapy and two and four weeks after radiotherapy completion. The primary objective was to demonstrate feasibility, defined as collection of step counts for 80% of the days during study subjects’ radiotherapy courses. Secondary objectives included establishing step count as a dynamic predictor of unplanned hospitalization risk. Results Thirty-eight enrolled patients were treated with concurrent chemoradiotherapy. Primary diagnoses included head and neck cancer (n=11), lung cancer (n=13), and a variety of GI cancers (n=14). Step data were collected for 1524 out of 1613 days (94%) during patients’ radiotherapy courses. Fourteen patients were hospitalized during radiotherapy or within four weeks of radiotherapy completion. Cox regression modeling demonstrated a significant association between recent step counts (3-day average) and hospitalization risk, with a 38% reduction in the risk of hospitalization for every 1,000 steps taken each day (HR = 0.62, 95% CI: 0.46 to 0.83, p=0.002). Inferior quality of life scores and impaired performance status were not associated with increased hospitalization risk. Conclusion Continuous activity monitoring during concurrent chemoradiotherapy is feasible and well-tolerated. Step counts may serve as powerful, objective, and dynamic indicators of hospitalization risk.

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Section: Introductionmentioning

confidence: 99%

Continuous Activity Monitoring During Concurrent Chemoradiotherapy

Ohri

Kabarriti

Bodner

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…For radiotherapy with curative intent, prolongation of the prescribed overall treatment time has been linked to inferior clinical outcomes [1–3]. This association appears to be consistent across many disease sites including head and neck cancer, cervical cancer, lung cancer, breast cancer, and other cancers [4, 5]. Prospective and retrospective studies have shown that treatment prolongation can increase the risk of local recurrence by up to 2% per day for certain malignancies [5].…”

Section: Introductionmentioning

confidence: 99%

“…It has also been reported that noncompliance may serve as a behavioral biomarker for other risk factors that contribute to poor outcomes, such as noncompliance with other important clinician visits and procedures, lack of social support, and mood disorders [4]. …”

Section: Introductionmentioning

confidence: 99%

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

et al. 2017

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BackgroundThe aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy.Patients and methodsPatients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction.ResultsIn all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3–4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF.ConclusionHF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF.

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“…Themetric for this parameter was <1 week of treatment break (not counting weekends) over the course of RT. We arrived at this metric based on prior studies demonstrating associations between RT break and disease outcomes [19]. We chose to evaluate intra-treatment breaks along with treatment duration because a simple measure of elapsed days does not differentiate between patients whose treatment course was prolonged because of a higher prescribed dose (such as those who required boosting) and those who had intra-treatment delivery delays that protracted the overall duration of treatment.…”

Section: Methodsmentioning

confidence: 99%

Challenges to delivery and effectiveness of adjuvant radiation therapy in elderly patients with node-positive vulvar cancer

Swanick

Eifel

Huo

et al. 2017

Gynecologic Oncology

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Objective To examine adjuvant radiation therapy (RT) use, patterns of RT delivery, and clinical outcomes in older patients with node-positive vulvar cancer. Methods Using SEER-Medicare linked data, we identified 444 patients (age≥66 years) with node-positive squamous cell vulvar carcinoma, without distant metastases, and treated with primary surgery between 1991 and 2009. We used claims to examine RT use and the following delivery metrics: 1) completion of ≥20 fractions, 2) treatment duration <8 weeks, 3) <1 week of intra-treatment break, and 4) treatment interval from surgery to start of RT <8 weeks. We tested associations between RT use and metrics with overall (OS) and cause-specific survival (CSS) using multivariate proportional hazards regression. Results Median age was 78 years (interquartile range [IQR]=74–83). Median follow-up was 17 months (IQR=9–40). Three hundred six patients (69%) received RT. Three delivery metrics were associated with improved outcomes: completion of ≥20 fractions, treatment duration <8 weeks, and <1 week of intra-treatment break. Patients who achieved these 3 metrics demonstrated better disease outcomes compared with surgery alone (OS hazard ratio [HR] for death=0.62, 95% confidence interval [CI]=0.46–0.82, P=0.001; CSS HR=0.58, 95% CI=0.40–0.85, P=0.005). Patients not achieving RT metrics demonstrated marginal improvements in disease outcomes over surgery alone (OS HR=0.73, 95% CI=0.55–0.99, P=0.04; CSS HR=0.76, 95% CI=0.52–1.11, P=0.16). Notably, only 51% of patients who received RT achieved all benchmarks. Conclusions In this cohort of older women with node-positive vulvar cancer, achieving metrics for RT delivery was an important factor for optimizing disease benefits from treatment.

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Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center

Cited by 81 publications

References 24 publications

Continuous Activity Monitoring During Concurrent Chemoradiotherapy

Continuous Activity Monitoring During Concurrent Chemoradiotherapy

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

Challenges to delivery and effectiveness of adjuvant radiation therapy in elderly patients with node-positive vulvar cancer

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