Epidemiologic study of compliance to postmastectomy radiation therapy guidelines in breast cancer patients in China between 1999 and 2008

Shu-Lian Wang; Ye-Xiong Li; Bao-Ning Zhang; Jing Li; Jin-Hu Fan; Yi Pang; Pin Zhang; Shan Zheng; Bin Zhang; Hong-Jian Yang; Xiao-Ming Xie; Zhong-Hua Tang; Hui Li; Jia-Yuan Li; Jian-Jun He; You-Lin Qiao

doi:10.1016/j.prro.2012.05.006

Epidemiologic study of compliance to postmastectomy radiation therapy guidelines in breast cancer patients in China between 1999 and 2008

Pract Radiat Oncol. 2013 Jul-Sep;3(3):209-215. doi: 10.1016/j.prro.2012.05.006. Epub 2012 Jun 27.

Authors

Shu-Lian Wang¹, Ye-Xiong Li², Bao-Ning Zhang³, Jing Li⁴, Jin-Hu Fan⁴, Yi Pang⁴, Pin Zhang⁵, Shan Zheng⁶, Bin Zhang⁷, Hong-Jian Yang⁸, Xiao-Ming Xie⁹, Zhong-Hua Tang¹⁰, Hui Li¹¹, Jia-Yuan Li¹², Jian-Jun He¹³, You-Lin Qiao⁴

Affiliations

¹ Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
² Department of Radiation Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: yexiong@yahoo.com.
³ Department of Breast Surgery, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
⁴ Department of Cancer Epidemiology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
⁵ Department of Medical Oncology, Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
⁶ Department of Pathology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
⁷ Department of Breast Surgery, Liaoning Cancer Hospital, Shenyang, China.
⁸ Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou, China.
⁹ Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
¹⁰ Department of Breast-thyroid Surgery, Xiangya Sencod Hospital, Central South University, Changsha, China.
¹¹ Department of Breast Surgery, the Second People's Hospital of Sichuan Province, Chengdu, China.
¹² Department of Epidemiology, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
¹³ Department of Oncosurgery, the First Affiliated Hospital of Medical College, Xi'an JiaoTong University, Xi'an, China.

PMID: 24674366
DOI: 10.1016/j.prro.2012.05.006

Abstract

Purpose: To evaluate compliance with postmastectomy radiation therapy (PMRT) guidelines in breast cancer patients in China over a 10-year period.

Methods and materials: A hospital-based, nationwide, multicenter retrospective epidemiologic study of primary breast cancer in women was conducted. Seven first-class, upper-level hospitals from different geographic regions of China were selected. One month was randomly selected to represent each year from 1999-2008 in every hospital. All inpatient cases within the selected months were reviewed and demographic, clinical, and pathologic characteristics and treatment patterns were collected. Patients enrolled in this study had to meet the following inclusion criteria: (1) treated with mastectomy and axillary dissection; (2) information regarding whether or not they received postmastectomy radiation therapy was available; and (3) information about staging was available. Patients were divided into 3 groups based on National Comprehensive Cancer Network guidelines. Utilization of PMRT in each group was analyzed and compared between different years and different hospitals.

Results: A total of 2310 patients were analyzed. There were 643 (27.8%) patients in the PMRT recommended group, 557 (24.1%) patients in the controversial group, and 1110 (48.1%) patients in the nonrecommended group. PMRT was used in 48.8% of patients in the recommended group, 15.6% in the controversial group, and 5.7% in the nonrecommended group. There was a trend toward increasing use of radiation therapy in the recommended and controversial groups from 1999-2008. The use of PMRT in the nonrecommended group remained relatively stable from 1999-2008. Fewer positive nodes and nonreceipt of chemotherapy or hormone therapy were associated with underuse of PMRT in the recommended group. In the controversial group, a higher ratio of positive nodes was associated with use of PMRT.

Conclusions: There is an apparent underuse of PMRT in the PMRT recommended group. Efforts should be made to improve the compliance to PMRT guidelines.