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Postmastectomy Radiotherapy: Barriers to Implementation in a Disparate Population
Tong Gan1, Bin Huang1, Quan Chen1
1From the *Department of Surgery, †Markey Cancer Center, and ‡Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
The American Surgeon
|May 12, 2020
Summary
Kentucky breast cancer patients, especially in Appalachian regions, show poor compliance with postmastectomy radiotherapy (PMRT). Improving access and adherence to PMRT is crucial for enhancing survival rates and reducing recurrence.
Area of Science:
- Oncology
- Public Health
- Health Services Research
Background:
- Appalachian Kentucky (AK) faces a disproportionately high breast cancer mortality rate.
- Postmastectomy radiotherapy (PMRT) is a crucial treatment for N2/N3 nodal disease, improving survival and reducing locoregional recurrence.
Purpose of the Study:
- To evaluate patient compliance with the quality measure of receiving PMRT within one year of diagnosis in Kentucky.
- To identify factors associated with PMRT compliance and its impact on patient outcomes.
Main Methods:
- A population-based retrospective review of 1489 patients with N2/N3 nodal disease who underwent mastectomy between 2006 and 2015, using the Kentucky Cancer Registry.
- Analysis of PMRT receipt, overall survival (OS), and disease-free survival (DFS), comparing Appalachian (AK) and non-Appalachian (non-AK) patients.
Main Results:
- Overall PMRT compliance was 66.6% (1104/1489); AK patients had lower compliance (58.3%) than non-AK patients (70%, P < 0.001).
- Factors independently associated with PMRT compliance included private insurance, higher education level, treatment at specific centers, and receipt of adjuvant chemotherapy.
- PMRT receipt was significantly associated with improved OS (P < 0.0001) and DFS (P < 0.0001). Appalachian status did not significantly impact OS or DFS.
Conclusions:
- Despite recommendations, PMRT compliance remains suboptimal in Kentucky, particularly in Appalachian regions.
- PMRT significantly improves survival and reduces recurrence for patients with advanced nodal disease.
- Interventions targeting insurance coverage, patient education, and adherence at nonacademic centers are necessary to enhance PMRT compliance and outcomes.
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