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Surgeon and Radiation Oncologist Views on Omission of Adjuvant Radiotherapy for Older Women with Early-Stage Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Although clinical trials have shown no survival advantage and only a modest improvement in local control from adjuvant radiotherapy after lumpectomy in older women with stage I, estrogen receptor-positive (ER+) breast cancer, radiotherapy is commonly administered, raising concerns about overtreatment. Therefore, we sought to evaluate physician views on omission of radiotherapy in older women with favorable prognosis breast cancer.

Methods

We surveyed a national sample of 713 radiation oncologists and 879 surgeons. Of these, 1504 were eligible and 825 responded (55%). We assessed responses to clinical scenarios, knowledge of pertinent risk information, and correlates of views on radiotherapy omission.

Results

Omission of radiotherapy in patients age ≥70 years with stage I, ER+ breast cancer, treated with lumpectomy and endocrine therapy, was felt to be unreasonable by 40% of surgeons and 20% of radiation oncologists. Many surgeons (29%) and radiation oncologists (10%) erroneously associated radiotherapy in older women with improvement in survival. Similarly, 32% of surgeons and 19% of radiation oncologists tended to substantially overestimate the risk of locoregional recurrence in older women with omission of RT. In a scenario with an 81-year-old with multiple comorbidities, 31% of surgeons and 35% of radiation oncologists would still recommend radiotherapy.

Conclusions

Many radiation oncologists and surgeons continue to consider omission of radiotherapy as substandard therapy and overestimate the benefits of radiotherapy. Surgeons, in addition to radiation oncologists, may have an opportunity to play a pivotal role in reducing overuse of aggressive care in this setting.

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Acknowledgement

This work was supported by a grant from the Conquer Cancer Foundation, the Breast Cancer Research Foundation, and intramural pilot project funding from the Cancer Surveillance and Outcomes Research Team (CanSORT) to D.S, and by the National Cancer Institute of the National Institutes of Health (P01CA163233). We thank Steven Katz, MD, MPH, Sarah Hawley, PhD, MPH, and Rose Juhasz, PhD for the scientific and administrative leadership of CanSORT and P01 elements that supported this work, and Research Management Team members Rebecca Morrison, MPH, Stefanie Goodell, BS, Alex Jeanpierre, MPH, and Rachel Tocco, MA, for their efforts in supporting this project. Study data were collected and managed using REDCap electronic data capture tools hosted at University of Michigan (Michigan Institute for Clinical & Health Research grant support CTSA: UL1TR000433).

Disclosure

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    Dean A. Shumway MD, Rochelle D. Jones MS, Julie M. Forstner MD, Terri L. Bott-Kothari MD & Reshma Jagsi MD, DPhil

  2. Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA

    Kent A. Griffith MS, MPH

  3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Michael S. Sabel MD & Jacqueline Jeruss MD, PhD

  4. Department of Medicine, University of Michigan, Ann Arbor, MI, USA

    Sarah T. Hawley PhD

Authors
  1. Dean A. Shumway MD
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  2. Kent A. Griffith MS, MPH
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  3. Michael S. Sabel MD
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  4. Rochelle D. Jones MS
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  5. Julie M. Forstner MD
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  6. Terri L. Bott-Kothari MD
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  7. Sarah T. Hawley PhD
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  8. Jacqueline Jeruss MD, PhD
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  9. Reshma Jagsi MD, DPhil
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Corresponding author

Correspondence to Reshma Jagsi MD, DPhil.

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Shumway, D.A., Griffith, K.A., Sabel, M.S. et al. Surgeon and Radiation Oncologist Views on Omission of Adjuvant Radiotherapy for Older Women with Early-Stage Breast Cancer. Ann Surg Oncol 24, 3518–3526 (2017). https://doi.org/10.1245/s10434-017-6013-1

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  • DOI: https://doi.org/10.1245/s10434-017-6013-1

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