The National Comprehensive Cancer Network, a consortium of the nation’s leading cancer experts, and the American Society for Clinicial Oncology set national guidelines for treating various cancers. Both groups recommend post-mastectomy radiation therapy for women with locally advanced breast cancer (cancer cells in 4 or more lymph nodes). Radiation is a crucial part of treatment for these women, because it greatly reduces recurrence and improves survival.
A new study, however, shows that only 65 percent of women who meet these guidelines actually have recommended radiation.
Using the National Cancer Data Base, researchers at Louisiana State University examined the medical records of 56,990 women who were diagnosed and treated for with N2/N3 breast cancers between 1998 and 2011. They were surprised to find that 35 percent of the women did not have recommended radiation after mastectomy; the study authors had expected a much higher rate of compliance.
But why wouldn’t women who are at high risk for recurrence and potentially life-threatening consequences follow through with a recommended treatment? None of the following factors seemed to independently influence compliance or noncompliance:
Only three factors were associated with compliance: being alive 30 days after surgery, being readmitted to the hospital within 30 days of surgery, or having chemotherapy (women who were treated with chemotherapy were 5.4 times more likely to have radiation therapy). These were statistical factors—none of the women were actually interviewed. The researchers could not tell from the medical records whether patients were unaware of their need for radiation therapy, if they refused it, or what their reasoning might be, indicating a need to additional research.
Source: Chu QD, Caldito G, Miller JK, et al. “Postmastectomy radiation for n2/n3 breast cancer: factors associated with low compliance rate.” Presented at the Southern Surgical Association 126th Annual Meeting, Palm Beach, FL, November 30–December 3, 2014. (http://www.journalacs.org/article/S1072-7515%2815%2900025-3/abstract)