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

• Published in: Annals of surgical oncology 2017-11, Vol.24 (12), p.3518-3526
• Main Authors: Shumway, Dean A., Griffith, Kent A., Sabel, Michael S., Jones, Rochelle D., Forstner, Julie M., Bott-Kothari, Terri L., Hawley, Sarah T., Jeruss, Jacqueline, Jagsi, Reshma
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Attitude of Health Personnel; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breast Oncology; Clinical trials; Endocrine therapy; Estrogen receptors; Female; Follow-Up Studies; Humans; Lumpectomy; Mastectomy, Segmental - psychology; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Oncology; Physicians; Practice Patterns, Physicians; Prognosis; Radiation Oncologists - psychology; Radiation therapy; Radiotherapy, Adjuvant - psychology; Surgeons; Surgeons - psychology; Surgery; Surgical Oncology; Survival
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-017-6013-1

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.