Factors associated with appropriate use of radiation therapy after mastectomy in women with Stage I-II breast cancer treated within the National Comprehensive Cancer Network (NCCN)

24 Background: Large population-based studies on TNBC epidemiology and treatment pattern in the US were generally limited due to lack of routinely data collection on these biomarkers until recent years. This study examined and documented general treatment status and factors associated with the treatments among TNBC patients in the US. Methods: We used the latest released NPCR and SEER combined cancer registry data, which covers 100% of the US population. All women in the US with a primary invasive TNBC breast cancer diagnosed between 2013 and 2015 were included. First course treatment patterns by AJCC staging on TNBC were examined based on corresponding year’s NCCN guideline recommendations. Regression analysis were performed to identify factors associated with treatments. Results: There were 74,952 TNBC women included in the study. Ninety three percent of women with early stage of TNBC had surgery, and 35% women with mastectomy chose to undergo contralateral prophylactic mastectomy. Among stage I-III patients, those aged < 35, Non-Hispanic Asian Pacific Islander, living in other regions than northeast or metropolitan were more likely to have mastectomy compared to BCS. Radiation therapy were only received for 65% women with breast conserving surgery (BCS), which were less likely to be performed in non-Hispanic Black, Hispanic, and among those aged < 35 or > 70+. Chemotherapy were received for 75% of TNBC women, ranged from 63% (stage I) to 86% (stage III). Treatment variations among different demographic and geographic characteristics in chemotherapy were also observed. Conclusions: Overall, current treatment practice for TNBC in the US is generally concordance with the recommended breast cancer care except a relative low radiation therapy among BCS women. However, treatment disparities existed within the limited treatment options, and factors associated with the disparities also varied. More effective treatment options and treatment equality are warranted to improve overall care of this subtype.

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The Use of Radiation As a Component of Breast Conservation Therapy in National Comprehensive Cancer Network Centers

Journal of Clinical Oncology ◽

10.1200/jco.2005.02.3127 ◽

2006 ◽

Vol 24 (3) ◽

pp. 361-369 ◽

Cited By ~ 62

Author(s):

Thomas A. Buchholz ◽

Richard L. Theriault ◽

Joyce C. Niland ◽

Melissa E. Hughes ◽

Rebecca Ottesen ◽

...

Keyword(s):

Breast Cancer ◽

National Comprehensive Cancer Network ◽

Invasive Breast Cancer ◽

Systemic Therapy ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Stage I ◽

Cancer Management ◽

Cancer Network ◽

Radiation Use

Purpose Benchmark data regarding quality measures of breast cancer management are needed. We investigated rates of radiation use after breast conservation therapy (BCT) for patients treated for ductal carcinoma-in-situ (DCIS) or invasive breast cancer at National Comprehensive Cancer Network (NCCN) centers. Patients and Methods We studied 3,333 consecutive patients treated between 1997 and 2002 with BCT for DCIS (n = 587) or for stage I or II breast cancer (n = 2,746) in eight NCCN centers. Results The overall rate of radiation therapy use was 91%, with a lower frequency of radiation use in DCIS versus invasive breast cancers (82% v 94%; odds ratio [OR] = 0.31; P < .0001). In a multivariable analysis of the patients with DCIS, the only factor significantly associated with lower rates of radiation use was low/intermediate grade (OR = 0.19; P = .0003). For patients with invasive breast cancer, significant factors were presence of comorbidity (OR = 0.53; P = .0005), tubular histology (OR = 0.39; P = .02), type of health insurance (P = .0072), and the NCCN institution (P = .0005). The model also showed lower rates of radiation use in patients with stage II disease who did not receive systemic therapy (OR = 0.01; P = .0001), younger patients who did not receive systemic therapy (P = .003); and older patients with stage I disease (P < .0001). Conclusion Radiation use as a component of BCT was high for patients seen at NCCN centers; however, there was variability in practice patterns noted across institutions. Radiation was most commonly omitted in patients with favorable disease characteristics, patients with comorbidities, and patients who also did not receive guideline-recommended systemic treatment.

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Factors associated with the addition of radiation therapy after mastectomy in women with stage I-II breast cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/s0360-3016(04)01107-1 ◽

2004 ◽

Vol 60 ◽

pp. S142-S143

Author(s):

R PUNGLIA ◽

M HUGHES ◽

S EDGE ◽

R THERIAULT ◽

M BOOKMAN ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Stage I ◽

Factors Associated

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Factors associated with the addition of radiation therapy after mastectomy in women with stage I-II breast cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2004.06.050 ◽

2004 ◽

Vol 60 (1) ◽

pp. S142-S143

Author(s):

R.S. Punglia ◽

M. Hughes ◽

S. Edge ◽

R. Theriault ◽

M. Bookman ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Stage I ◽

Factors Associated

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The impact of sociodemographic factors on the utilization of radiation therapy in breast cancer patients in Estonia: a register-based study

International Journal for Equity in Health ◽

10.1186/s12939-021-01497-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Fereshteh Shahrabi Farahani ◽

Keiu Paapsi ◽

Kaire Innos

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Cancer Registry ◽

Psychosocial Support ◽

Sociodemographic Factors ◽

Stage I ◽

Equal Access ◽

Administrative Databases ◽

The Impact ◽

Over Time

Abstract Background Radiation therapy is an important part of multimodal breast cancer treatment. The aim was to examine the impact of sociodemographic factors on radiation therapy use in breast cancer (BC) patients in Estonia, linking cancer registry data to administrative databases. Methods Estonian Cancer Registry provided data on women diagnosed with BC in Estonia in 2007–2018, including TNM stage at diagnosis. Use of radiation therapy within 12 months of diagnosis was determined from Estonian Health Insurance Funds claims, and sociodemographic characteristics from population registry. Receipt of radiation therapy was evaluated over time and by clinical and sociodemographic factors. Poisson regression with robust variance was used to calculate univariate and multivariate prevalence rate ratios (PRR) with 95 % confidence intervals (CI) for receipt of radiation therapy among stage I–III BC patients age < 70 years who underwent primary surgery. Results Overall, of 8637 women included in the study, 4310 (50 %) received radiation therapy within 12 months of diagnosis. This proportion increased from 39 to 58 % from 2007 to 2009 to 2016–2018 (p < 0.001). Multivariate regression analysis showed that compared to women with stage I BC, those with more advanced stage were less likely to receive radiation therapy. Receipt of radiation therapy increased significantly over time and was nearly 40 % higher in 2016–2018 than in 2007–2009. Use of radiation therapy was significantly lower for women with the lowest level of education compared to those with a university degree (PRR 0.88, 95 % CI 0.80–0.97), and for divorced/widowed women (PRR 0.95, 95 % CI 0.91–0.99) and single women (PRR 0.92, 95 % CI 0.86–0.99), compared to married women. Age at diagnosis, nationality and place of residence were not associated with receipt of radiation therapy. Conclusions The study showed considerable increase in the use of radiation therapy in Estonia over the study period, which is in line with increases in available equipment. The lack of geographic variations suggests equal access to therapy for patients living in remote regions. However, educational level and marital status were significantly associated with receipt of radiation therapy, highlighting the importance of psychosocial support in ensuring equal access to care.

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