One Decade Later: Trends and Disparities in the Application of Post-Mastectomy Radiotherapy Since the Release of the American Society of Clinical Oncology Clinical Practice Guidelines
Purpose In 2001 ASCO published practice guidelines for post mastectomy radiotherapy (PMRT). We analyzed factors that influence the receipt of radiotherapy therapy and trends over time. Methods and Materials We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2012-08, Vol.83 (5), p.e591-e596 |
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| container_title | International journal of radiation oncology, biology, physics |
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| creator | Dragun, Anthony E., MD Huang, Bin, DrPh, MS Gupta, Saurabh, BS Crew, John B., MD Tucker, Thomas C., PhD, MPH |
| description | Purpose In 2001 ASCO published practice guidelines for post mastectomy radiotherapy (PMRT). We analyzed factors that influence the receipt of radiotherapy therapy and trends over time. Methods and Materials We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or III breast cancer between 1995 and 2008 using data from the Kentucky Cancer Registry. We categorized patients according to ASCO group: group 1, PMRT not routinely recommended (T2, N0); group 2, PMRT controversial/evidence insufficient (T1-2, N1); group 3, PMRT recommended or suggested (T3-4 or N2-3). Probability of receiving PMRT was assessed using logistic regression. Results Overall, 24.0% of women received PMRT over the study period. The rates of PMRT for group 1, 2, and 3 were 7.5%, 19.5%, and 47.3%, respectively. Since 2001, there was an increase in the use of PMRT (from 21.1%-26.5%, P |
| doi_str_mv | 10.1016/j.ijrobp.2012.02.002 |
| format | Article |
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We analyzed factors that influence the receipt of radiotherapy therapy and trends over time. Methods and Materials We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or III breast cancer between 1995 and 2008 using data from the Kentucky Cancer Registry. We categorized patients according to ASCO group: group 1, PMRT not routinely recommended (T2, N0); group 2, PMRT controversial/evidence insufficient (T1-2, N1); group 3, PMRT recommended or suggested (T3-4 or N2-3). Probability of receiving PMRT was assessed using logistic regression. Results Overall, 24.0% of women received PMRT over the study period. The rates of PMRT for group 1, 2, and 3 were 7.5%, 19.5%, and 47.3%, respectively. Since 2001, there was an increase in the use of PMRT (from 21.1%-26.5%, P <.0001), which occurred mainly among group 3 members (from 40.8%-51.2%, P <.0001). The average rate remained constant in group 1 (from 7.1%-7.4%, P =.266) and decreased in group 2 (from 20.0%-18.1%, P <.0001). On multivariate analysis, the rate of PMRT was significantly lower for women aged >70 years (vs. younger), rural Appalachia (vs. non-Appalachia) populations, and Medicaid (vs. privately insured) patients. Conclusions ASCO guidelines have influenced practice in an underserved state; however PMRT remains underused, even for highest-risk patients. Barriers exist for elderly, rural and poor patients, which independently predict for lack of adequate care. Updated guidelines are needed to clarify the use of PMRT for patients with T1-2, N1 disease.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2012.02.002</identifier><identifier>PMID: 22768990</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Aged ; ASCO ; Breast Neoplasms - pathology ; Breast Neoplasms - radiotherapy ; Breast Neoplasms - surgery ; Female ; Guideline Adherence - trends ; Guideline Adherence - utilization ; HEALTH HAZARDS ; Hematology, Oncology and Palliative Medicine ; Humans ; Kentucky ; Logistic Models ; Lymph Node Excision - utilization ; MAMMARY GLANDS ; Mastectomy ; Medically Underserved Area ; Middle Aged ; MULTIVARIATE ANALYSIS ; NEOPLASMS ; PATIENTS ; Postoperative Period ; Practice guidelines ; Practice Guidelines as Topic ; Radiation Oncology - standards ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; Radiotherapy, Adjuvant - trends ; Radiotherapy, Adjuvant - utilization ; RECOMMENDATIONS ; Societies, Medical - standards ; SURGERY ; United States ; WOMEN</subject><ispartof>International journal of radiation oncology, biology, physics, 2012-08, Vol.83 (5), p.e591-e596</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-8f290b1c5dca2baf9c4b7a9ad67658dac47780f9708e35311ef66b57ad19d31c3</citedby><cites>FETCH-LOGICAL-c445t-8f290b1c5dca2baf9c4b7a9ad67658dac47780f9708e35311ef66b57ad19d31c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301612002088$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22768990$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22149379$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Dragun, Anthony E., MD</creatorcontrib><creatorcontrib>Huang, Bin, DrPh, MS</creatorcontrib><creatorcontrib>Gupta, Saurabh, BS</creatorcontrib><creatorcontrib>Crew, John B., MD</creatorcontrib><creatorcontrib>Tucker, Thomas C., PhD, MPH</creatorcontrib><title>One Decade Later: Trends and Disparities in the Application of Post-Mastectomy Radiotherapy Since the Release of the American Society of Clinical Oncology Clinical Practice Guidelines</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose In 2001 ASCO published practice guidelines for post mastectomy radiotherapy (PMRT). We analyzed factors that influence the receipt of radiotherapy therapy and trends over time. Methods and Materials We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or III breast cancer between 1995 and 2008 using data from the Kentucky Cancer Registry. We categorized patients according to ASCO group: group 1, PMRT not routinely recommended (T2, N0); group 2, PMRT controversial/evidence insufficient (T1-2, N1); group 3, PMRT recommended or suggested (T3-4 or N2-3). Probability of receiving PMRT was assessed using logistic regression. Results Overall, 24.0% of women received PMRT over the study period. The rates of PMRT for group 1, 2, and 3 were 7.5%, 19.5%, and 47.3%, respectively. Since 2001, there was an increase in the use of PMRT (from 21.1%-26.5%, P <.0001), which occurred mainly among group 3 members (from 40.8%-51.2%, P <.0001). The average rate remained constant in group 1 (from 7.1%-7.4%, P =.266) and decreased in group 2 (from 20.0%-18.1%, P <.0001). On multivariate analysis, the rate of PMRT was significantly lower for women aged >70 years (vs. younger), rural Appalachia (vs. non-Appalachia) populations, and Medicaid (vs. privately insured) patients. Conclusions ASCO guidelines have influenced practice in an underserved state; however PMRT remains underused, even for highest-risk patients. Barriers exist for elderly, rural and poor patients, which independently predict for lack of adequate care. Updated guidelines are needed to clarify the use of PMRT for patients with T1-2, N1 disease.</description><subject>Age Factors</subject><subject>Aged</subject><subject>ASCO</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Breast Neoplasms - surgery</subject><subject>Female</subject><subject>Guideline Adherence - trends</subject><subject>Guideline Adherence - utilization</subject><subject>HEALTH HAZARDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Kentucky</subject><subject>Logistic Models</subject><subject>Lymph Node Excision - utilization</subject><subject>MAMMARY GLANDS</subject><subject>Mastectomy</subject><subject>Medically Underserved Area</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>NEOPLASMS</subject><subject>PATIENTS</subject><subject>Postoperative Period</subject><subject>Practice guidelines</subject><subject>Practice Guidelines as Topic</subject><subject>Radiation Oncology - standards</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>Radiotherapy, Adjuvant - trends</subject><subject>Radiotherapy, Adjuvant - utilization</subject><subject>RECOMMENDATIONS</subject><subject>Societies, Medical - standards</subject><subject>SURGERY</subject><subject>United States</subject><subject>WOMEN</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkl2LEzEUhgdR3Lr6D0QC3ngzNcl8xgth6eoqVLpsV_AuZJIzbuo0GZNUmF_m3_PMtip4IxwIHJ73zfnKsueMLhll9evd0u6C78Ylp4wvKQblD7IFaxuRF1X15WG2oEVN8wLhs-xJjDtKKWNN-Tg747ypWyHoIvu5cUAuQSsDZK0ShDfkNoAzkShnyKWNowo2WYjEOpLugFyM42C1StY74nty7WPKP6mYQCe_n8iNMtYjF9Q4ka11Gu5VNzCAijAr7k32ENDEka3XFtI051eDdZgbyMZpP_iv09_MdVA6WbS6OlgDmIX4NHvUqyHCs9N7nn1-_-529SFfb64-ri7WuS7LKuVtzwXtmK6MVrxTvdBl1yihTN3UVWuULpumpb1oaAtFVTAGfV13VaMME6ZgujjPXh59sU8ro7bY6J32zmG_knNWiqIRSL06UmPw3w8Qk9zbqGEYlAN_iJJRXhalYFWLaHlEdfAxBujlGOxehQkhOS9W7uRxsXJerKQYlKPsxemHQ7cH80f0e5MIvD0CgNP4YSHMxQLO39gw12q8_d8P_xro0_y_wQRx5w_B4aQlkxEFcjsf13xbjKOatm3xC-r2zTw</recordid><startdate>20120801</startdate><enddate>20120801</enddate><creator>Dragun, Anthony E., MD</creator><creator>Huang, Bin, DrPh, MS</creator><creator>Gupta, Saurabh, BS</creator><creator>Crew, John B., MD</creator><creator>Tucker, Thomas C., PhD, MPH</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20120801</creationdate><title>One Decade Later: Trends and Disparities in the Application of Post-Mastectomy Radiotherapy Since the Release of the American Society of Clinical Oncology Clinical Practice Guidelines</title><author>Dragun, Anthony E., MD ; Huang, Bin, DrPh, MS ; Gupta, Saurabh, BS ; Crew, John B., MD ; Tucker, Thomas C., PhD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-8f290b1c5dca2baf9c4b7a9ad67658dac47780f9708e35311ef66b57ad19d31c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>ASCO</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Breast Neoplasms - surgery</topic><topic>Female</topic><topic>Guideline Adherence - trends</topic><topic>Guideline Adherence - utilization</topic><topic>HEALTH HAZARDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Kentucky</topic><topic>Logistic Models</topic><topic>Lymph Node Excision - utilization</topic><topic>MAMMARY GLANDS</topic><topic>Mastectomy</topic><topic>Medically Underserved Area</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>NEOPLASMS</topic><topic>PATIENTS</topic><topic>Postoperative Period</topic><topic>Practice guidelines</topic><topic>Practice Guidelines as Topic</topic><topic>Radiation Oncology - standards</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>Radiotherapy, Adjuvant - trends</topic><topic>Radiotherapy, Adjuvant - utilization</topic><topic>RECOMMENDATIONS</topic><topic>Societies, Medical - standards</topic><topic>SURGERY</topic><topic>United States</topic><topic>WOMEN</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dragun, Anthony E., MD</creatorcontrib><creatorcontrib>Huang, Bin, DrPh, MS</creatorcontrib><creatorcontrib>Gupta, Saurabh, BS</creatorcontrib><creatorcontrib>Crew, John B., MD</creatorcontrib><creatorcontrib>Tucker, Thomas C., PhD, MPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dragun, Anthony E., MD</au><au>Huang, Bin, DrPh, MS</au><au>Gupta, Saurabh, BS</au><au>Crew, John B., MD</au><au>Tucker, Thomas C., PhD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>One Decade Later: Trends and Disparities in the Application of Post-Mastectomy Radiotherapy Since the Release of the American Society of Clinical Oncology Clinical Practice Guidelines</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>83</volume><issue>5</issue><spage>e591</spage><epage>e596</epage><pages>e591-e596</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose In 2001 ASCO published practice guidelines for post mastectomy radiotherapy (PMRT). We analyzed factors that influence the receipt of radiotherapy therapy and trends over time. Methods and Materials We analyzed 8889 women who underwent mastectomy as primary surgical treatment for stage II or III breast cancer between 1995 and 2008 using data from the Kentucky Cancer Registry. We categorized patients according to ASCO group: group 1, PMRT not routinely recommended (T2, N0); group 2, PMRT controversial/evidence insufficient (T1-2, N1); group 3, PMRT recommended or suggested (T3-4 or N2-3). Probability of receiving PMRT was assessed using logistic regression. Results Overall, 24.0% of women received PMRT over the study period. The rates of PMRT for group 1, 2, and 3 were 7.5%, 19.5%, and 47.3%, respectively. Since 2001, there was an increase in the use of PMRT (from 21.1%-26.5%, P <.0001), which occurred mainly among group 3 members (from 40.8%-51.2%, P <.0001). The average rate remained constant in group 1 (from 7.1%-7.4%, P =.266) and decreased in group 2 (from 20.0%-18.1%, P <.0001). On multivariate analysis, the rate of PMRT was significantly lower for women aged >70 years (vs. younger), rural Appalachia (vs. non-Appalachia) populations, and Medicaid (vs. privately insured) patients. Conclusions ASCO guidelines have influenced practice in an underserved state; however PMRT remains underused, even for highest-risk patients. Barriers exist for elderly, rural and poor patients, which independently predict for lack of adequate care. Updated guidelines are needed to clarify the use of PMRT for patients with T1-2, N1 disease.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22768990</pmid><doi>10.1016/j.ijrobp.2012.02.002</doi></addata></record> |
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| subjects | Age Factors Aged ASCO Breast Neoplasms - pathology Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Female Guideline Adherence - trends Guideline Adherence - utilization HEALTH HAZARDS Hematology, Oncology and Palliative Medicine Humans Kentucky Logistic Models Lymph Node Excision - utilization MAMMARY GLANDS Mastectomy Medically Underserved Area Middle Aged MULTIVARIATE ANALYSIS NEOPLASMS PATIENTS Postoperative Period Practice guidelines Practice Guidelines as Topic Radiation Oncology - standards Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY Radiotherapy, Adjuvant - trends Radiotherapy, Adjuvant - utilization RECOMMENDATIONS Societies, Medical - standards SURGERY United States WOMEN |
| title | One Decade Later: Trends and Disparities in the Application of Post-Mastectomy Radiotherapy Since the Release of the American Society of Clinical Oncology Clinical Practice Guidelines |
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