In 2004, a randomized clinical trial supported the omission of radiation treatment in elderly female patients with early-stage breast cancer. Despite this evidence, a new study reports that almost two-thirds of this group of patients still receive this treatment today.
The randomized clinical trial – often regarded to be the “gold standard” in evidence-based medicine – demonstrated that the administering of radiation to patients who had received surgery and the drug tamoxifen did not improve 5-year recurrence rates or survival rates in elderly women diagnosed with early-stage tumors.
Radiation therapy has been considered the standard treatment for early-stage breast cancer for many years. However, it appears that practitioners are reluctant to change their ways. In the new study, published in Cancer, the authors state that the omission of radiotherapy has not been widely adopted into clinical practice.
They cite a recent assessment of the nation’s largest cancer registry, the Surveillance, Epidemiology and End Results (SEER)-Medicare database. Among women aged over 70, 76.5% received radiation treatment, and little change was observed in treatment practice before and after the publication of the 2004 study.
This particular analysis only examined the beneficiaries of Medicare, and it is uncertain whether their treatment is representative of general practice patterns.
Dr. Rachel Blitzblau of Duke University in Durham, NC, and her colleagues examined further data from the SEER database for their study, in order to assess the full extent to which elderly female patients still receive radiation therapy for early-stage breast cancer.
A total of 40,583 patients aged over 70 were identified who received a lumpectomy – a surgical procedure to remove a breast tumor – between 2000 and 2009. The researchers analyzed what treatment these female patients received, comparing treatment given before and after the publication of the 2004 study.
From 2000-2004, prior to the publication of the randomized clinical trial results, 68.6% of patients had a form of radiation therapy. In comparison, the researchers found that from 2005-2009, 61.7% of patients received this form of treatment.
The researchers did note that after 2004, there was a slight change in the form that radiation therapy took. Rather than receiving radiation treatment to the entire breast, more patients were found to receive a short course of more focused radiation treatment to a specific part of the breast.
Despite this shift, the results suggest that the publication of the 2004 trial results has had a relatively low impact on standard practice patterns.
Dr. Blitzblau and her colleagues believe this could be explained by concerns with the trial’s relatively short 5-year follow-up period, and that physicians are incentivized to favor treatment over no treatment.
“Our findings highlight the fact that it may be challenging for practitioners to incorporate clinical trial data that involves omitting a treatment that was previously considered standard of care,” she says. “If a treatment regimen has been working well, and data are new, there can be concern that de-escalation of treatment may ultimately be shown to worsen outcomes.”
Whether specific procedures or treatments are unnecessary or cause harm has been a cause for debate widely in recent times, tied into a need within the medical community for financially efficient medical care.
The American Society for Radiation Oncology have recommended against using whole-breast radiotherapy in women aged over 50 for early-stage breast cancer without first considering a shorter treatment schedule.
“Although shorter treatment schedules are more convenient for patients and less costly for the health care system, the omission of radiotherapy in women aged >70 years with early-stage, hormone receptor-positive breast cancer would achieve these goals while sparing patients the potential acute and late toxicities associated with radiotherapy,” write the authors.
Results for the trial published last year indicate that recurrence rates were still low in patients that had not received radiation therapy. Dr. Blitzbau is interested to see if these findings go on to have a larger impact on practice patterns.
Last month, Medical News Today reported on a study finding that almost a quarter of breast conservation operations led to further surgery. The researchers questioned whether new guidelines for surgery could reduce this number.