Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
2884 - Early-Stage Breast Cancer Patient Demographic Predictors of Adjuvant Radiation Therapy Completion in the United States
Presenter(s)
Maya Stephens, MS, BS - Medical College of Georgia, Augusta, GA
M. J. Stephens1,2, E. Becker3, M. Gordon4, A. I. Stump2, K. Ding3, and S. McClelland III5; 1Medical College of Georgia, Augusta, GA, 2University of Oklahoma College of Medicine, Oklahoma City, OK, 3University of Oklahoma Health Sciences Center, Oklahoma City, OK, 4University of Oklahoma Health Science Center, Oklahoma City, OK, 5University of Oklahoma Stephenson Cancer Center, oklahoma, OK
Purpose/Objective(s):
Over the last decade, short-course hypofractionated radiation therapy (HFRT) has gained widespread acceptance and is now considered the new standard-of-care for adjuvant whole breast irradiation (WBI) in early-stage breast cancers (ESBC). Unlike the traditional 5-6 weeks of standard fractionation (SFRT) regimen, HFRT delivers radiation over a shorter course – typically 3-4 weeks - for adjuvant radiation therapy (RT) following lumpectomy. Benefits of HFRT include reduced side effect profile, increased treatment completion, improved convenience to patients, and decreased financial toxicity. In 2018, the American Society for Radiation Oncology (ASTRO) published guidelines outlining HFRT recommendations to support the adoption of hypofractionated WBI for breast cancer treatment. Previous work identified several factors associated with lower odds of completion such as distance to treatment center, older age, and patient race. We report the results of a recent nationwide analysis of patient demographic factors contributing to adjuvant RT completion in ESBC.Materials/Methods:
The National Cancer Database (NCDB) was utilized to identify patients in the United States diagnosed with ESBC between 2018-2022 having received lumpectomy and adjuvant RT. Consistent with previous work, HFRT was defined as 2.66-2.70 Gray (Gy)/fraction, while SFRT fraction size was defined as a 1.8-2.0 Gy/fraction. RT completion was defined as receiving at least 40 Gy for HFRT and 46 Gy for SFRT. Multivariable logistic regression models characterized predictors for RT completion.Results:
A total of 34,043 patients were identified. Overall, 96% of participants completed their prescribed RT, of which 83% received HFRT and 9% SFRT. RT completion rates were significantly greater among patients undergoing HFRT (97%) compared to SFRT (82%) (P<0.0001). In multivariable logistic regression analysis, patient demographic factors significantly associated with increased adjuvant RT treatment completion were higher median income, treatment at a community cancer program over an academic center, closer distance to treatment facility, geographic location (East North Central, Middle Atlantic, Pacific, and West North Central), and receipt of HFRT (P < 0.05).Conclusion:
Within the context of short-course RT continuing to expand as the preferred nationwide method of treatment of WBI, our findings indicate that following lumpectomy, ESBC patients receiving SFRT were 718% less likely odds of completing adjuvant RT than patients receiving HFRT. Additional demographic predictors of RT completion included patient residence within 20 miles from treatment, treatment at a community cancer center, US geographic location, and higher median income. These findings further highlight patient demographic factors which can be targeted to increase optimization of guideline-concordant care in ESBC.