Radiotherapy Utilization for Patients Over Age 60 With Early Stage Breast Cancer.

{"article_title":"Radiotherapy Utilization for Patients Over Age 60 With Early Stage Breast Cancer.","author":"Paulsson AK, Fowble B, Lazar AA, Park C, Sherertz T","journal_title":"Clinical breast cancer","issn":"1938-0666","isbn":"","publication_date":"2020 Apr","volume":"20","issue":"2","first_page":"168","page_count":"","accession_number":"31744755","doi":"10.1016\/j.clbc.2019.10.005","publisher":"Elsevier","doctype":"Journal Article","subjects":"Breast Neoplasms therapy; Guideline Adherence statistics & numerical data; Mastectomy, Segmental; Patient Acceptance of Health Care statistics & numerical data; Practice Patterns, Physicians' statistics & numerical data; Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal standards; Antineoplastic Agents, Hormonal therapeutic use; Breast Neoplasms diagnosis; Breast Neoplasms pathology; Chemotherapy, Adjuvant standards; Chemotherapy, Adjuvant statistics & numerical data; Evidence-Based Medicine standards; Evidence-Based Medicine statistics & numerical data; Female; Guideline Adherence standards; Humans; Middle Aged; Neoplasm Staging; Practice Guidelines as Topic; Practice Patterns, Physicians' standards; Prognosis; Radiation Oncology standards; Radiation Oncology statistics & numerical data; Radiotherapy, Adjuvant standards; Radiotherapy, Adjuvant statistics & numerical data; Risk Assessment; Treatment Outcome","interest_area":["Oncology"," Obstetrics & Gynecology"],"abstract":"Introduction: Recent studies have questioned the relative benefit of radiotherapy (RT) for older patients with favorable breast cancer given the lack of survival benefit and marginal local control benefit. Despite the 2004 National Comprehensive Cancer Network (NCCN) guidelines advocating for the option of hormonal therapy alone, trends in utilization rates of RT in this group are not well-documented. We analyzed our institutional experience with implementation of the guidelines over time. Material and Methods: We identified 564 patients aged ? 60 years with favorable breast cancer treated with breast conserving surgery from 2000 to 2017. Patients met criteria for Cancer and Leukemia Group B (CALGB) 9343, Postoperative Radiotherapy in Minimum Risk Elderly (PRIME II), or the very-low risk cohort identified in the Toronto-British Columbia study. Multivariable logistic regression analysis was performed to assess the magnitude of association between omission status, grade, and tumor size while controlling for age and year of diagnosis. Results: Overall RT omission rates were 17.6% prior to the 2004 NCCN update and 45% after the publication of the 10-year CALGB data in 2013. The overall RT omission rate was 29%. Patients with grade 1 to 2 histology (odds ratio, 3.2; 95% confidence interval, 1.3-7.7; P = .01) and tumors < 1 cm (odds ratio, 1.60; 95% confidence interval, 0.4-0.9; P = .007) were more likely to omit RT than those with higher grade or larger tumors. Conclusions: We observed a slight decrease in the use of RT over time, suggesting a move towards adoption of the NCCN guidelines. There remains a fundamental need to continue to individualize breast cancer care based on risk stratification and make evidenced-based treatment recommendations with equitable use of health care resources. Copyright \ufffd 2019 Elsevier Inc. All rights reserved.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=31744755&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Paulsson AK, Fowble B, Lazar AA, Park C, Sherertz T","Journal_Info":"Publisher: Elsevier Country of Publication: United States NLM ID: 100898731 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1938-0666 (Electronic) Linking ISSN: 15268209 NLM ISO Abbreviation: Clin Breast Cancer Subsets: MEDLINE","Publication_Type":"Journal Article","Published_Date":"2020-04-01","Source":"Clinical breast cancer [Clin Breast Cancer] 2020 Apr; Vol. 20 (2), pp. 168-173. Date of Electronic Publication: 2019 Oct 25.","Languages":"English","Electronic_ISSN":"1938-0666","MeSH_Terms":"Mastectomy, Segmental*, Breast Neoplasms\/*therapy , Guideline Adherence\/*statistics & numerical data , Patient Acceptance of Health Care\/*statistics & numerical data , Practice Patterns, Physicians'\/*statistics & numerical data, Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal\/standards ; Antineoplastic Agents, Hormonal\/therapeutic use ; Breast Neoplasms\/diagnosis ; Breast Neoplasms\/pathology ; Chemotherapy, Adjuvant\/standards ; Chemotherapy, Adjuvant\/statistics & numerical data ; Evidence-Based Medicine\/standards ; Evidence-Based Medicine\/statistics & numerical data ; Female ; Guideline Adherence\/standards ; Humans ; Middle Aged ; Neoplasm Staging ; Practice Guidelines as Topic ; Practice Patterns, Physicians'\/standards ; Prognosis ; Radiation Oncology\/standards ; Radiation Oncology\/statistics & numerical data ; Radiotherapy, Adjuvant\/standards ; Radiotherapy, Adjuvant\/statistics & numerical data ; Risk Assessment ; Treatment Outcome","Subjects":"Age Factors, Aged, Aged, 80 and over, Antineoplastic Agents, Hormonal standards, Antineoplastic Agents, Hormonal therapeutic use, Breast Neoplasms diagnosis, Breast Neoplasms pathology, Chemotherapy, Adjuvant standards, Chemotherapy, Adjuvant statistics & numerical data, Evidence-Based Medicine standards, Evidence-Based Medicine statistics & numerical data, Female, Guideline Adherence standards, Humans, Middle Aged, Neoplasm Staging, Practice Guidelines as Topic, Practice Patterns, Physicians' standards, Prognosis, Radiation Oncology standards, Radiation Oncology statistics & numerical data, Radiotherapy, Adjuvant standards, Radiotherapy, Adjuvant statistics & numerical data, Risk Assessment, Treatment Outcome, Breast Neoplasms therapy, Guideline Adherence statistics & numerical data, Mastectomy, Segmental, Patient Acceptance of Health Care statistics & numerical data, Practice Patterns, Physicians' statistics & numerical data","Title_Abbreviations":"Clinical breast cancer","Volume":"20"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"31744755","RelevancyScore":"853","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"852.928771972656"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=31744755&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=31744755&authtype=shib&custid=ns346513&group=main&profile=eds"}