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Postmastectomy radiotherapy for breast cancer†

Patterns, correlates, communication, and insights into the decision process

  1. Reshma Jagsi MD, DPhil1,‡,*,
  2. Paul Abrahamse MA2,
  3. Monica Morrow MD3,
  4. Jennifer J. Griggs MD, MPH2,
  5. Kendra Schwartz MD, MSPH4,
  6. Steven J. Katz MD, MPH5,6

Article first published online: 29 JAN 2009

DOI: 10.1002/cncr.24164

Issue

Cancer

Cancer

Volume 115, Issue 6, pages 1185–1193, 15 March 2009

Additional Information

How to Cite

Jagsi, R., Abrahamse, P., Morrow, M., Griggs, J. J., Schwartz, K. and Katz, S. J. (2009), Postmastectomy radiotherapy for breast cancer. Cancer, 115: 1185–1193. doi: 10.1002/cncr.24164

Author Information

  1. 1

    Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan

  2. 2

    Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan

  3. 3

    Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

  4. 4

    Department of Family Medicine and Public Health Services, Wayne State University School of Medicine, Detroit, Michigan

  5. 5

    Departments of Medicine and Health Management and Policy, University of Michigan, Ann Arbor, Michigan

  6. 6

    VA Center for Clinical Management Research, Health Services Research and Development and the Ann Arbor VA Center for Practice Management, Ann Arbor, Michigan

  1. ‡

    Fax: (734) 763-7370

*Department of Radiation Oncology, University of Michigan, UHB2C490, SPC 5010, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5010

  1. †

    The collection of cancer incidence data used in this publication was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885. The ideas and opinions expressed herein are those of the author, and no endorsement by the State of California, Department of Health Services is intended or should be inferred.

  2. ‡

    Fax: (734) 763-7370

Publication History

  1. Issue published online: 3 MAR 2009
  2. Article first published online: 29 JAN 2009
  3. Manuscript Accepted: 8 OCT 2008
  4. Manuscript Revised: 6 OCT 2008
  5. Manuscript Received: 18 JUL 2008

Funded by

  • National Cancer Institute. Grant Numbers: RO1 CA8837, K05 CA111340
  • National Cancer Institute, National Institutes of Health, Department of Health and Human Services. Grant Numbers: N01-PC-35,139, NO1-PC-65,064

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Keywords:

  • mastectomy;
  • radiotherapy;
  • breast neoplasms;
  • guideline adherence;
  • quality of healthcare

Abstract

BACKGROUND:

Given accumulating evidence supporting postmastectomy radiotherapy (PMRT) in selected patients, it is important to evaluate patterns and correlates of PMRT utilization, including communication and attitudinal factors.

METHODS:

The authors surveyed 2382 patients diagnosed with breast cancer in 2002 and reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries (n=1844, 77.4% response rate). Analyses were restricted to patients with nonmetastatic invasive breast cancer treated by mastectomy who had decided whether or not to undergo PMRT (n=396). The authors assessed rates of explanation, recommendation, and receipt of radiation by indication grouping, defined primarily by the 2001 American Society of Clinical Oncology guidelines. They evaluated correlates of PMRT receipt, including tumor and sociodemographic characteristics. They also explored patients' self-reported reasons for nonreceipt of PMRT.

RESULTS:

The adjusted proportion in each indication group reporting that a provider had explained radiation was high (77% of those in whom PMRT was indicated, 76% of those in whom medical opinion was divided, and 73% of those in whom PMRT was not indicated; P = .10). The adjusted proportions reporting recommendations for radiation (86%, 35%, and 17%, respectively) and receipt (81%, 34%, and 10%, respectively) varied significantly by indication grouping (P < .001). On multivariate analysis, tumor size (P < .001), lymph node status (P < .001), comorbidity (P = .02), and chemotherapy receipt (P = .003) were found to be independent significant correlates of PMRT receipt. The most common reasons cited for not pursuing PMRT were lack of physician recommendation and perceived lack of need.

CONCLUSIONS:

PMRT receipt is strongly correlated with clinical indication. The authors found no sociodemographic disparities in utilization. However, approximately one‒fifth of patients with strong indications did not receive treatment. Cancer 2009. © 2009 American Cancer Society.

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