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Time to Adjuvant Radiotherapy in Breast Cancer Affects Survival: Implications for the American College of Surgeons Commission on Cancer Quality Metrics

  • Health Services Research and Global Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

To optimize breast cancer care, the American College of Surgeons Commission on Cancer developed quality measures regarding receipt and timing of adjuvant radiotherapy (RT). Nationwide compliance with these measures and its impact on overall survival (OS) are evaluated herein.

Patients and Methods

Patients (n = 285,291) diagnosed with invasive breast cancer from 2004 to 2012 were identified from the National Cancer Database. Compliance with RT administration within 365 days from diagnosis was determined for patients with stage III disease with ≥ 4 positive lymph nodes post mastectomy and stage I–III disease post breast-conserving surgery (BCS). Univariate and multivariate logistic regression and Cox proportional hazard models were used to assess factors associated with compliance and OS, respectively.

Results

In the mastectomy cohort, 66.9% received timely RT, showing improved OS versus no RT patients (HR 0.70, 95% CI 0.67–0.73). Delayed RT patients (≥ 365 days) achieved equivalent OS to those receiving timely RT (HR 1.07, 95% CI 0.93–1.23) and superior OS to no RT patients (HR 0.74, 95% CI 0.65–0.85). In the BCS cohort, 89.4% received timely RT, showing improved OS versus no RT patients (HR 0.47, 95% CI 0.45–0.49). Delayed RT was associated with improved OS versus no RT (HR 0.64, 95% CI 0.56–0.74) and decreased OS versus timely RT (HR 1.37, 95% CI 1.19–1.58). Factors associated with noncompliance included insurance type and distance to hospital.

Conclusions

Quality measure compliance with adjuvant RT improves OS, regardless of timing after mastectomy. However, timeliness does impact OS after BCS. Focus on modifiable factors to improve compliance such as access to care may lead to improved compliance and OS.

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Acknowledgements

This manuscript has been presented in part at the Society of Surgical Oncology Annual Cancer Symposium and in part at the American Society of Breast Surgeons Annual Meeting in 2017. The manuscript is not under consideration for publication at another journal.

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Authors and Affiliations

  1. Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA

    Vasilena Zheleva MD & Lily L. Lai MD

  2. Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA

    Rebecca A. Nelson PhD

  3. Department of Surgery, McGill University, Montreal, QC, Canada

    Sinziana Dumitra MD, MSc(Epi), FRCSC3

  4. Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA

    Nayana L. Vora MD

Authors
  1. Vasilena Zheleva MD
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  2. Rebecca A. Nelson PhD
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  3. Sinziana Dumitra MD, MSc(Epi), FRCSC3
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Correspondence to Lily L. Lai MD.

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Electronic supplementary material

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Supplementary Figure 1

Forest plot. Multivariate Cox proportional hazard analysis of patient, tumor and treatment factors associated with improved overall survival in the BCS cohort – Stage I only (PDF 33 kb)

Supplementary Figure 2

Forest plot. Multivariate Cox proportional hazard analysis of patient, tumor and treatment factors associated with improved overall survival in the BCS cohort – Stage II only (PDF 33 kb)

Supplementary Figure 3

Forest plot. Multivariate Cox proportional hazard analysis of patient, tumor and treatment factors associated with improved overall survival in the BCS cohort – Stage III only (PDF 33 kb)

Supplementary material 4 (DOCX 23 kb)

Supplementary material 5 (DOCX 25 kb)

Supplementary material 6 (DOCX 25 kb)

Supplementary material 7 (DOCX 21 kb)

Supplementary material 8 (DOCX 24 kb)

Supplementary material 9 (DOCX 24 kb)

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Zheleva, V., Nelson, R.A., Dumitra, S. et al. Time to Adjuvant Radiotherapy in Breast Cancer Affects Survival: Implications for the American College of Surgeons Commission on Cancer Quality Metrics. Ann Surg Oncol 27, 2614–2625 (2020). https://doi.org/10.1245/s10434-020-08326-8

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  • DOI: https://doi.org/10.1245/s10434-020-08326-8

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