Patient Experiences and Clinician Views on the Role of Radiotherapy for Ductal Carcinoma In-Situ

Publication date: Available online 9 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Dean A. Shumway, Chandler M. McLeod, Monica Morrow, Yun Li, Allison W. Kurian, Aaron Sabolch, Ann S. Hamilton, Kevin C. Ward, Steven J. Katz, Sarah T. Hawley, Reshma Jagsi
PurposeTo evaluate patient experiences with decisions regarding radiotherapy for ductal carcinoma in situ (DCIS), and to assess clinician views on the role of radiotherapy for DCIS with favorable features in the present era.MethodsA sample of women with newly diagnosed breast cancer from the population-based Georgia and Los Angeles County (LA) SEER registries were sent surveys approximately 2 months after undergoing breast conserving surgery (70% response rate). The analytic sample was limited to 538 respondents with unilateral DCIS. We also surveyed 761 surgeons and radiation oncologists treating breast cancer in those regions, of whom 539 responded (71%).ResultsAfter breast conserving surgery (BCS), 23% of patients omitted radiotherapy, with twice the rate of omission in LA relative to Georgia (31% vs 16%, p<0.001). The most common reasons for omitting radiotherapy were advice from a clinician that it wasn't needed (62%) and concern about side effects (24%). Cost and transportation were not reported as influential considerations. After covariate adjustment, low and intermediate grade disease (OR 5.5, 95% CI 2.5-12; OR 3.2, 95% CI 1.7-6.1) and LA SEER site (OR 4.3, 95% CI 2.3-8.2) were significantly associated with greater radiotherapy omission. Among responding clinicians, 62% would discuss radiotherapy omission for a patient with DCIS with favorable features. Clinicians in LA were more likely to discuss radiotherapy omission than those in Georgia (67% vs 56%, p = 0.01). Approximately one-third of clinicians would obtain the Oncotype DX DCIS Score.ConclusionsThere continues to be substantial heterogeneity in radiotherapy omission after breast conserving surgery for DCIS, with systematic differences in provider opinions across the two regions we studied. Enhanced precision of recurrence estimates, guidance from professional organizations, and better communication are needed to improve the consistency of treatment in this controversial area.

Teaser

In a population-based survey of patients with DCIS, we observed that a quarter of patients omit radiotherapy after breast conserving surgery, with a two-fold difference in the rate of radiotherapy omission between the 2 SEER regions studied. In a corresponding survey of clinicians, we observed systematic differences in opinions between the two SEER regions regarding the role of radiation.


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