Postmastectomy radiotherapy: Barriers to implementation in a disparate population

Tong Gan; Bin Huang; Quan Chen; Patrick C. McGrath; B. Mark Evers; Emily F. Marcinkowski

Postmastectomy radiotherapy: Barriers to implementation in a disparate population

Tong Gan
, Bin Huang
, Quan Chen
, Patrick C. McGrath
, B. Mark Evers
, Emily F. Marcinkowski

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Appalachian Kentucky (AK) has a disproportionally high breast cancer mortality rate. Postmastectomy radiotherapy (PMRT) in N2/N3 nodal disease improves survival and locoregional recurrence. We evaluated Kentucky patient compliance to the quality measure of PMRT received within one year of diagnosis. A population-based retrospective review of patients who received mastectomy with N2/N3 nodal disease from 2006 to 2015 was obtained through the Kentucky Cancer Registry. A total of 1489 patients met the inclusion criteria. Of these, 1104 (66.6%) received PMRT. AK patients were less likely to receive PMRT (58.3%) than non-AK patients (70%, P < 0.001). After adjusting for significant factors, private insurance, education level, treatment center, and receipt of adjuvant chemotherapy were independently associated with PMRT compliance. Patients who received PMRT had improved overall survival (OS, P < 0.0001) and disease-free survival (DFS, P < 0.0001). Appalachian status was not a major factor in OS (P5 0.1929) or DFS (P 5 0.5840). Nearly two decades after the recommendation of PMRT, compliance remains poor in Kentucky. PMRT continues to be a major factor in survival and recurrence in this population. Interventions focusing on improving insurance coverage, education level, and guideline adherence in nonacademic centers are needed to improve compliance.

Original language	English
Pages (from-to)	377-385
Number of pages	9
Journal	American Surgeon
Volume	86
Issue number	4
State	Published - Apr 1 2020

Bibliographical note

Publisher Copyright:
© 2020 Southeastern Surgical Congress. All rights reserved.

Funding

supported by the National Cancer Institute Surveillance Epidemiology and End Results Program (NCI HHSN26100001), and the Center for Disease Control and Prevention National Program of Cancer Registries (CDC U58 DP005400). This study was also supported by the Markey Cancer Center Support Grant (NCI P30 CA177558) and T32 NIH Training Grant (T32 CA160003). The Center for Clinical and Translational Sciences is funded through the NIH National Center for Advancing Translational Sciences (UL1TR001998). We would like to thank the Kentucky Cancer Registry for providing data regarding breast cancer patients. We would like to thank the University of Kentucky Research Communications Office for aiding in figure preparation. Disclosure: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article. Data collection activities of the Kentucky Cancer Registry are supported by the National Cancer Institute Surveillance Epidemiology and End Results Program (NCI HHSN26100001), and the Center for Disease Control and Prevention National Program of Cancer Registries (CDC U58 DP005400). This study was also supported by the Markey Cancer Center Support Grant (NCI P30 CA177558) and T32 NIH Training Grant (T32 CA160003). The Center for Clinical and Translational Sciences is funded through the NIH National Center for Advancing Translational Sciences (UL1TR001998).

Funders	Funder number
Kentucky Cancer Registry
Markey Cancer Center's Cancer Center Support	P30 CA177558
National Cancer Institute Surveillance Epidemiology and End Results Program
University of Kentucky Research Communications Office
National Institutes of Health (NIH)	T32 CA160003
National Institutes of Health (NIH)
National Childhood Cancer Registry – National Cancer Institute	HHSN26100001, CDC U58 DP005400
National Childhood Cancer Registry – National Cancer Institute
National Center for Advancing Translational Sciences (NCATS)	UL1TR001998
National Center for Advancing Translational Sciences (NCATS)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Surgery

Cite this

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title = "Postmastectomy radiotherapy: Barriers to implementation in a disparate population",

abstract = "Appalachian Kentucky (AK) has a disproportionally high breast cancer mortality rate. Postmastectomy radiotherapy (PMRT) in N2/N3 nodal disease improves survival and locoregional recurrence. We evaluated Kentucky patient compliance to the quality measure of PMRT received within one year of diagnosis. A population-based retrospective review of patients who received mastectomy with N2/N3 nodal disease from 2006 to 2015 was obtained through the Kentucky Cancer Registry. A total of 1489 patients met the inclusion criteria. Of these, 1104 (66.6\%) received PMRT. AK patients were less likely to receive PMRT (58.3\%) than non-AK patients (70\%, P < 0.001). After adjusting for significant factors, private insurance, education level, treatment center, and receipt of adjuvant chemotherapy were independently associated with PMRT compliance. Patients who received PMRT had improved overall survival (OS, P < 0.0001) and disease-free survival (DFS, P < 0.0001). Appalachian status was not a major factor in OS (P5 0.1929) or DFS (P 5 0.5840). Nearly two decades after the recommendation of PMRT, compliance remains poor in Kentucky. PMRT continues to be a major factor in survival and recurrence in this population. Interventions focusing on improving insurance coverage, education level, and guideline adherence in nonacademic centers are needed to improve compliance.",

author = "Tong Gan and Bin Huang and Quan Chen and McGrath, \{Patrick C.\} and \{Mark Evers\}, B. and Marcinkowski, \{Emily F.\}",

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N2 - Appalachian Kentucky (AK) has a disproportionally high breast cancer mortality rate. Postmastectomy radiotherapy (PMRT) in N2/N3 nodal disease improves survival and locoregional recurrence. We evaluated Kentucky patient compliance to the quality measure of PMRT received within one year of diagnosis. A population-based retrospective review of patients who received mastectomy with N2/N3 nodal disease from 2006 to 2015 was obtained through the Kentucky Cancer Registry. A total of 1489 patients met the inclusion criteria. Of these, 1104 (66.6%) received PMRT. AK patients were less likely to receive PMRT (58.3%) than non-AK patients (70%, P < 0.001). After adjusting for significant factors, private insurance, education level, treatment center, and receipt of adjuvant chemotherapy were independently associated with PMRT compliance. Patients who received PMRT had improved overall survival (OS, P < 0.0001) and disease-free survival (DFS, P < 0.0001). Appalachian status was not a major factor in OS (P5 0.1929) or DFS (P 5 0.5840). Nearly two decades after the recommendation of PMRT, compliance remains poor in Kentucky. PMRT continues to be a major factor in survival and recurrence in this population. Interventions focusing on improving insurance coverage, education level, and guideline adherence in nonacademic centers are needed to improve compliance.

AB - Appalachian Kentucky (AK) has a disproportionally high breast cancer mortality rate. Postmastectomy radiotherapy (PMRT) in N2/N3 nodal disease improves survival and locoregional recurrence. We evaluated Kentucky patient compliance to the quality measure of PMRT received within one year of diagnosis. A population-based retrospective review of patients who received mastectomy with N2/N3 nodal disease from 2006 to 2015 was obtained through the Kentucky Cancer Registry. A total of 1489 patients met the inclusion criteria. Of these, 1104 (66.6%) received PMRT. AK patients were less likely to receive PMRT (58.3%) than non-AK patients (70%, P < 0.001). After adjusting for significant factors, private insurance, education level, treatment center, and receipt of adjuvant chemotherapy were independently associated with PMRT compliance. Patients who received PMRT had improved overall survival (OS, P < 0.0001) and disease-free survival (DFS, P < 0.0001). Appalachian status was not a major factor in OS (P5 0.1929) or DFS (P 5 0.5840). Nearly two decades after the recommendation of PMRT, compliance remains poor in Kentucky. PMRT continues to be a major factor in survival and recurrence in this population. Interventions focusing on improving insurance coverage, education level, and guideline adherence in nonacademic centers are needed to improve compliance.

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Postmastectomy radiotherapy: Barriers to implementation in a disparate population

Abstract

Bibliographical note

Funding

UN SDGs

ASJC Scopus subject areas

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