Significant Variation in Radiation Use in Breast Cancer

Allison Gandey

July 13, 2007

July 13, 2007 (Chicago) — A new study shows there are gaps in cancer care and not everyone who should be is receiving radiation with breast-conserving therapy. At the recent American Society of Clinical Oncology 43rd Annual Meeting, researchers reported on nationwide use of radiation to determine the extent of variation and the need for improvement.

"Despite limiting measurement to populations that should clearly receive therapy, there are significant variations associated with patient and institutional characteristics," lead author Stephen Edge, MD, from the Roswell Park Cancer Institute, in Buffalo, New York, said during his presentation. "Reporting cancer care quality data is important, and the use of radiation with breast-conserving therapy is a key quality measure for improvement and provider accountability."

Together with colleagues from the American College of Surgeons in Chicago, Illinois, Dr. Edge looked at data from more than 1300 hospitals reporting to the National Cancer Data Base. The study looked at women under the age of 70 years treated with breast-conserving therapy for invasive breast cancer. The analysis focused on factors associated with the use of radiation in a multivariate model.

The investigators found that among the more than 90,600 women under the age of 70 years, radiation was reported withbreast-conserving therapy in 74.5%. Radiation began within 6 months of diagnosis in 54% and 1 year in 74.2%. On multivariable analysis, radiation was significantly less common among African American and Hispanic patients vs white women. And patients with less education, no insurance, or Medicaid or who were treated in nonurban areas or at low-volume hospitals were also less likely to receive therapy.

Radiation was administered to 73% of women in nonurban hospitals and to 82% of women in urban hospitals. It was given to 75% of women aged 50 to 59 years and 77% of women aged 60 to 69 years. Younger women were less likely to receive radiation — 68% in those under 40 years and 72% in those aged 40 to 49 years.

Selected Factors Affecting Use of Radiation with Breast Conserving Therapy on Multivariate Analysis

Factors
Comparator
Category
Odds Ratio
95% CI
P
Age (y)
<40
50 – 59
1.196
1.108 – 1.292
< .0001
60 – 69
1.294
1.193 – 1.404
< .0001
Ethnicity
White
African American
0.814
.763 – .868
< .0001
Hispanic
0.758
.692 – .829
< .0001
Charlson comorbidity
0
>1
0.916
.853 – .983
.015
Insurance
None
Medicaid
0.998
.835 – 1.191
.978
Private or
managed care
1.216
1.033 – 1.431
.019
Hospital location
Nonurban
Urban
1.718
1.617 – 1.824
< .0001
Hospital breast case volume
1st – 2nd highest quartiles
3rd – 4th quartiles
0.789
.744 – .837
< .0001


The National Quality Forum's new accountability cancer quality measures include careful specification of target populations and are designed to limit omission of recommended therapy. One measure included is the use of radiation with breast-conservingtherapy.

This study shows that despite quality measures, gaps continue to exist and patients are often overlooked. Dr. Edge and his team conclude, "There is need for improvement to meet these tight specifications."

American Society of Clinical Oncology 43rd Annual Meeting: Abstract 599. Presented June 2, 2007.

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