Radiotherapy still used despite evidence of little benefit in some elderly patients with early breast cancer
Trial results have little effect on clinical care at the bedside
- Date : 12 Mar 2012
- Topic : Breast cancer
Even though a large clinical study demonstrated that radiation has limited benefit in the postoperative treatment of some elderly patients with early breast cancer after breast-conserving surgery, there was little change in the use of radiation among older women in the Medicare program, Yale School of Medicine researchers report in the March issue of the Journal of Clinical Oncology.
According to lead author Dr Cary Gross, associate professor of internal medicine at Yale School of Medicine and a member of Yale Cancer Center, clinical trials are considered the gold standard of medical research and in this case the trial was influential enough to lead to a change in treatment guidelines. The researchers expected it to have more of an impact on clinical care at the bedside.
Many older women have low risk for breast cancer recurrence
The typical course of treatment for older women with early stage breast cancer is breast-conserving surgery followed by radiation therapy. The purpose of added radiation therapy is to reduce recurrence of the disease. However, many elderly women have less aggressive tumours that place them at low risk for tumour recurrence.
The Yale team studied the impact of a large research trial funded by the USA National Cancer Institute (NCI) on clinical practice. Published in 2004, that NCI trial found that radiation therapy had only a small benefit for some women 70 and older with early stage, low-risk breast cancer. As a result of this study, breast cancer treatment guidelines were changed to indicate that radiation therapy could be considered optional for such patients.
But in the years following implementation of the new guidelines, Gross and his colleagues found that there has been minimal impact on the clinical care of older women with breast cancer. The team looked at the use of radiation therapy among Medicare beneficiaries diagnosed with early stage breast cancer before and after the large NCI clinical trial was published. About 79% of women received radiation prior to the study compared with 75% after.
Even among the oldest women (85-94 years), the trial appeared to have little effect on clinician practice: The use of radiation decreased from 37% prior to the study to 33% after.
Implications on how the results of clinical research studies are translated into practice
These findings have important implications for how the results of clinical research studies are translated into practice. Dr Gross points out that the USA government invested over $1 billion in comparative effectiveness research as part of the American Recovery and Reinvestment Act of 2009, and it should be ensured that the results of such research extend beyond the journal page and are actually incorporated into clinical decision-making.
The National Cancer Institute funded the study.
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