TY - JOUR
T1 - Adjuvant radiation and outcomes after breast conserving surgery in publicly insured patients
AU - Kimmick, Gretchen G.
AU - Camacho, Fabian
AU - Hwang, Wenke
AU - Mackley, Heath
AU - Stewart, John
AU - Anderson, Roger T.
N1 - Funding Information:
This work was supported by funding from the National Cancer Institute at the National Institutes of Health grant no. R01-CA121317-3 to Roger Anderson, PhD.
PY - 2012/4
Y1 - 2012/4
N2 - Objectives: Epidemiologic studies report that lack of adjuvant radiation (RT) after breast conserving surgery (BCS) is associated with higher short-term mortality. It is generally accepted that adjuvant RT decreases risk of breast cancer recurrence and thereby lowers long-term mortality; here, we explore reasons for its relationship to short-term mortality. Materials and Methods: We studied 1583 publically insured women who had BCS between 1998 and 2002 (mean 71.8. years, range 27-101), of whom 1346 (85%) received RT. Multivariate analyses with Cox Proportional Hazards and Logistic Regression models included: age; race; comorbidity; insurance status; tumor size; number of nodes positive; hormone receptor status; receipt of radiation; adjuvant chemotherapy; preventive care - including mammography, Pap smear and primary care visits; and hospitalization. Results: At a mean follow-up of 52.8. months, overall mortality was significantly lower in those who received RT (HR 0.45, p < 0.0001) and higher with older age (HR 1.05, p < 0.0001) and greater comorbidity (HR 1.16, p = 0.0007). Local recurrence was less with receipt of optimal radiation (HR 0.47; p = 0.03). Breast cancer event, as determined by a clinically logical algorithm to detect breast cancer recurrence and death, however, was not significantly associated with receipt of RT (OR 1.32, p = 0.2). Conclusion: These results imply that the higher short-term mortality in women not receiving RT after BCS is related to factors other than breast cancer recurrence.
AB - Objectives: Epidemiologic studies report that lack of adjuvant radiation (RT) after breast conserving surgery (BCS) is associated with higher short-term mortality. It is generally accepted that adjuvant RT decreases risk of breast cancer recurrence and thereby lowers long-term mortality; here, we explore reasons for its relationship to short-term mortality. Materials and Methods: We studied 1583 publically insured women who had BCS between 1998 and 2002 (mean 71.8. years, range 27-101), of whom 1346 (85%) received RT. Multivariate analyses with Cox Proportional Hazards and Logistic Regression models included: age; race; comorbidity; insurance status; tumor size; number of nodes positive; hormone receptor status; receipt of radiation; adjuvant chemotherapy; preventive care - including mammography, Pap smear and primary care visits; and hospitalization. Results: At a mean follow-up of 52.8. months, overall mortality was significantly lower in those who received RT (HR 0.45, p < 0.0001) and higher with older age (HR 1.05, p < 0.0001) and greater comorbidity (HR 1.16, p = 0.0007). Local recurrence was less with receipt of optimal radiation (HR 0.47; p = 0.03). Breast cancer event, as determined by a clinically logical algorithm to detect breast cancer recurrence and death, however, was not significantly associated with receipt of RT (OR 1.32, p = 0.2). Conclusion: These results imply that the higher short-term mortality in women not receiving RT after BCS is related to factors other than breast cancer recurrence.
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U2 - 10.1016/j.jgo.2012.01.004
DO - 10.1016/j.jgo.2012.01.004
M3 - Article
C2 - 22712029
AN - SCOPUS:84863405179
SN - 1879-4068
VL - 3
SP - 138
EP - 146
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 2
ER -