Radiotherapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center

Publication date: Available online 30 January 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nitin Ohri, Bruce D. Rapkin, Chandan Guha, Shalom Kalnicki, Madhur Garg
BackgroundPatient noncompliance with daily external beam radiotherapy (RT) is a prevalent issue in some patient populations. Here we examine associations between RT noncompliance and clinical outcomes.MethodsWe reviewed all patients who completed courses of external beam RT with curative intent in our department from the years 2007-2012 for cancers of the head and neck, breast, lung, cervix, uterus, or rectum. Patients who missed two or more scheduled RT appointments (excluding planned treatment breaks) were deemed noncompliant. Univariate, multivariable, and propensity-matched analyses were performed to examine associations between RT noncompliance and clinical outcomes.Results266/1,227 patients (21.7%) were noncompliant. With median follow-up of 50.9 months, 108 recurrences (8.8%) and 228 deaths (18.6%) occurred. In univariate analyses, RT noncompliance was associated with increased recurrence risk (5-year cumulative incidence 16% v. 7%, p<0.001), inferior recurrence-free survival (RFS, 5-year actuarial rate 63% v. 79%, p<0.001), and inferior overall survival (OS, 5-year actuarial rate 72% v. 83%, p<0.001). In multivariable analyses that were adjusted for disease site and stage, comorbidity score, gender, ethnicity, race, and socioeconomic status (SES), RT noncompliance was associated with inferior recurrence, RFS, and OS rates. Propensity score matched models yielded results nearly identical to those seen in univariate analyses. Low SES was associated with RT noncompliance and was associated with inferior clinical outcomes in univariate analyses, but SES was not associated with inferior outcomes in multivariable models.ConclusionFor cancer patients being treated with curative intent, RT noncompliance is associated with inferior clinical outcomes. The magnitudes of these effects demonstrate that RT noncompliance can serve as a behavioral biomarker to identify high-risk patients who require additional interventions. Treatment compliance may mediate the associations that have observed linking SES and clinical outcomes.

Teaser

Patient noncompliance with daily external beam radiotherapy (RT) is a prevalent issue in some patient populations. The present analysis demonstrates that, in a large cohort of patients who were treated with curative intent, RT noncompliance was associated with increased risk of disease recurrence and death. The magnitudes of these effects demonstrate that RT noncompliance may serve as a behavioral biomarker to identify high-risk patients who require additional interventions to achieve optimal outcomes.


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