바로가기  >

Abstract
BACKGROUND:
The omission of radiotherapy (RT) after lumpectomy is a reasonable option for many older women with favorable-prognosis breast cancer. In the current study, we sought to evaluate patient perspectives regarding decision making about RT.

METHODS:
Women aged 65 to 79 years with AJCC 7th edition stage I and II breast cancer who were reported to the Georgia and Los Angeles County Surveillance, Epidemiology, and End Results registries were surveyed (response rate, 70%) regarding RT decisions, the rationale for omitting RT, decision-making values, and understanding of disease recurrence risk. We also surveyed their corresponding surgeons (response rate, 77%). Patient characteristics associated with the omission of RT were evaluated using multilevel, multivariable logistic regression, accounting for patient clustering within surgeons.

RESULTS:
Of 999 patients, 135 omitted RT (14%). Older age, lower tumor grade, and having estrogen receptor-positive disease each were found to be strongly associated with omission of RT in multivariable analyses, whereas the number of comorbidities was not. Non-English speakers were more likely to omit RT (adjusted odds ratio, 5.9; 95% confidence interval, 1.4-24.5). The most commonly reported reasons for RT omission were that a physician advised the patient that it was not needed (54% of patients who omitted RT) and patient choice (41%). Risk of local disease recurrence was overestimated by all patients: by approximately 2-fold among those who omitted RT and by approximately 8-fold among those who received RT. The risk of distant disease recurrence was overestimated by approximately 3-fold on average.

CONCLUSIONS:
To some extent, decisions regarding RT omission are appropriately influenced by patient age, tumor grade, and estrogen receptor status, but do not appear to be optimally tailored according to competing comorbidities. Many women who are candidates for RT omission overestimate their risk of disease recurrence.

Author information

Shumway DA1, Griffith KA2, Hawley ST3,4,5, Wallner LP3,6, Ward KC7, Hamilton AS8, Morrow M9, Katz SJ3,4, Jagsi R1.
1
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
2
Center for Cancer Biostatistics, University of Michigan, Ann Arbor, Michigan.
3
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
4
Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan.
5
Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, Michigan.
6
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
7
Department of Epidemiology, Emory University, Atlanta, Georgia.
8
Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.
9
Breast Surgical Service, Memorial Sloan Kettering Cancer Center, New York, New York.