International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationRadiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center
Introduction
In most curative settings, external beam radiation therapy (RT) for the treatment of solid tumors is delivered 5 days each week over multiple weeks in an outpatient setting. Unintended treatment prolongation, generally attributed to treatment toxicity or intercurrent illness (1), has been associated with inferior tumor control in a number of disease sites (2).
Several relatively small series have explored RT adherence in specific disease sites (3) and demonstrated associations between RT noncompliance and adverse tumor biology (4), poor treatment efficacy (5), and inferior long-term clinical outcomes (4). Ohri et al, recently identified RT noncompliance as a prevalent issue among patients receiving RT in our Cancer Center with curative intent (6). Approximately 20% of patients were deemed to be noncompliant, and statistically significant predictors of noncompliance risk included diagnosis, treatment course length, and socioeconomic status (SES). In this report we examine whether RT noncompliance is associated with clinical outcomes in our patient population.
Section snippets
Data collection and patient selection
We queried our department's electronic medical record (Varian Medical Systems, Palo Alto, CA) to identify all patients treated with external beam RT with curative intent at our institution in the years 2007 to 2012 and to tabulate the number of scheduled RT appointments that those patients missed (“no-shows”). Treatments that are cancelled by physicians (eg, owing to treatment toxicity) or because of machine issues in our department are coded as “cancelled” and therefore do not affect patient
Patient characteristics
We identified 5370 patients who were treated with RT in our department from the years 2007 to 2012. A total of 2284 of these patients were treated with curative intent for head and neck, breast (including DCIS), lung, rectal, prostate, cervical, or uterine carcinoma and completed their external beam RT course. Of those patients, 1852 had demographic, cancer staging, and follow-up data available in CLG. After excluding subjects with DCIS and prostate cancer, for whom crude rates of clinical
Discussion
In this analysis we have found that treatment noncompliance is associated with inferior clinical outcomes for patients receiving RT with curative intent. The associations we detected were both statistically significant and clinically meaningful and consistent across disease sites. This is a novel finding that may have significant implications for how cancer care delivery can be improved, particularly in disadvantaged patient populations.
Some may view the association between RT noncompliance and
Conclusion
For cancer patients being treated with curative intent, RT noncompliance is associated with inferior clinical outcomes. The magnitudes of these effects demonstrate that RT noncompliance can serve as a behavioral biomarker to identify high-risk patients who require additional interventions. Treatment compliance may mediate the associations that have been observed linking SES and clinical outcomes.
Acknowledgments
The authors thank Alex Lukaj and Jose Fret for their tireless efforts.
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Conflict of interest: none.