Almost Half of American Women With Advanced Breast Cancer Do not Undergo Recommended Radiation Therapy

Forty-five percent of women in the United States with advanced breast cancer did not receive post-mastectomy radiation therapy (PMRT), despite evidence-based guidelines that state the treatment effectively prolongs survival.

PMRT rates have remained stable since 1999 for women with advanced breast cancer, according to a study published in the July issue of Cancer. Of nearly 5,000 women with high-risk breast cancer diagnosed between 1999 to 2005, only 55 percent received radiation therapy, reported Benjamin Smith, M.D., the lead author of the study with the University of Texas MD Anderson Cancer Center.

At the same time, PMRT use increased among patients with an intermediate risk, even though established guidelines do not strongly recommend the treatment for this patient population.
They searched the Surveillance, Epidemiology and End Results (SEER) Medicare database to identify women 66-years-old and older who had undergone a mastectomy for invasive breast cancer between 1992 and 2005. The patient characteristics included the year of the diagnosis, age, race, marital status, SEER registry, urban/rural residence, median income, education and co-morbid conditions that spanned from one to 12 months before the diagnosis. The patient data were then evaluated to determine low-risk, intermediate-risk and high-risk groups based on tumor-related variables that were consistent with current guidelines.

“The findings add to the debate on the effectiveness of standardized treatment guidelines,” says Smith. “There’s a clear gap between the scientific evidence demonstrating PMRT’s benefits and the proper use of the therapy in everyday clinical practice.”

By 2002, the National Cancer Institute, the American Society of Clinical Oncology and the National Comprehensive Cancer Network had published a series of evidence-based guidelines on PMRT, Smith and colleagues pointed out in the article. The guidelines were based on three landmark, randomized trials that proved PMRT decreased locoregional recurrence and improved survival rates for women with high-risk breast cancer.

Based on their findings, Smith et al suggested the following strategies to bring clinical evidence into practice:

• Require compliance for accreditation. “Organizations like the American College of Surgeons Commission on Cancer and the National Quality Forum track compliance with evidence-based guidelines as part of their accreditation process. Adding the PRMT guidelines to the already established list of quality measures would likely increase the use of PMRT among high-risk patients.”
• Create financial incentives. “Payers with widespread networks have an opportunity to influence evidence-based practice with financial incentives.”
• Use electronic medical records (EMRs). “EMRs can be used by government organizations, like the Centers for Medicare and Medicaid Services, to measure quality and compliance.”
• Push for cancer societies to promote accountability. “Encourage societies like the American Society for Therapeutic Radiology and Oncology (ASTRO) and the American Society for Clinical Oncology (ASCO) to promote the use of PMRT guidelines among its members.”