Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer

To use patient self-report to provide more valid estimates of whether radiotherapy (RT) is
underutilized than possible with registry data, as well as to evaluate for disparities and the
influence of preferences and provider interactions.
We considered 2,260 survey respondents who had nonmetastatic breast cancer, were age 20
to 79 years, were diagnosed between July 2005 and February 2007 in Detroit and Los Angeles,
and reported to Surveillance, Epidemiology and End Results (SEER) registries (72% response
rate). Survey responses were merged with SEER data. We assessed rates and correlates of RT
receipt among all patients with invasive cancer receiving breast-conserving surgery (BCS) and
among patients undergoing mastectomy with indications for RT (ie, positive lymph nodes or
T3-4 tumors).
Among 904 patients undergoing BCS with strong indications for RT, 95.4% received RT, and
77.6% received RT among the 135 patients undergoing mastectomy with strong indications
(P  .001). Among 114 patients undergoing BCS with weaker indications (ie, elderly) for RT, 80.0%
received treatment, and 47.5% received RT among the 164 patients undergoing mastectomy with
weaker indications (T1N1, T2N1, or T3N0 disease; P  .001). On multivariate analysis, surgery
type (P  .001), indication strength (P  .001), age (P  .005), comorbidity (P  .001), income
(P  .03), patient desire to avoid RT (P  .001), level of surgeon involvement in decision to have
radiation (P  .001), and SEER site (P  .001) were significantly associated with likelihood of
RT receipt.
RT receipt was consistently high across sociodemographic subgroups after BCS but was lower
after mastectomy, even among patients with strong indications for treatment, in whom clinical
benefit is similar. Surgeon involvement had a strong influence on RT receipt.
J Clin Oncol 28:2396-2403. © 2010 by American Society of Clinical Oncology

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