Intraoperative radiotherapy for early breast cancer: do health professionals choose convenience or risk?

Radiation Oncology

Anna K Nowak³  Max Bulsara¹  Christobel Saunders²  David Joseph⁴  Tammy Corica⁵ 

[1] Institute of Health and Research, University of Notre Dame, 19 Mouat Street, P.O Box 1225, Fremantle, WA 6959, Australia;School of Surgery, University of Western Australia, MBDP M507, Crawley, WA 6009, Australia;School of Medicine and Pharmacology, University of Western Australia, MBDP M503, Crawley, WA 6009, Australia;Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia;Radiation Oncology Clinical Trials and Research Unit, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia

关键词: PBI;    IORT;    Preference questionnaire;    TARGIT;    Partial breast irradiation;    Intraoperative radiotherapy;    Breast cancer;    Patient preferences;    Treatment preference;    Physician survey;   

Others  :  814939
DOI  :  10.1186/1748-717X-9-33

 received in 2013-11-12, accepted in 2014-01-20,  发布年份 2014

【 摘 要 】

Background

The randomized TARGIT trial comparing experimental intra-operative radiotherapy (IORT) to up to 7 weeks of daily conventional external beam radiotherapy (EBRT) recruited participants in Western Australia between 2003 and 2012. We aimed to understand preferences for this evolving radiotherapy treatment for early breast cancer (EBC) in health professionals, and how they changed over time and in response to emerging data. Preferences for single dose IORT or EBRT for EBC were elicited in 2004 and 2011, together with factors that may be associated with these preferences.

Methods

Western Australian health professionals working with breast cancer patients were invited to complete a validated, self-administered questionnaire. The questionnaire used hypothetical scenarios and trade-off methodology to determine the maximum increase in risk of local recurrence health professionals were willing to accept in order to have a single dose of IORT in the place of EBRT if they were faced with this decision themselves.

Results

Health professional characteristics were similar across the two time points although 2011 included a higher number of nurse (49% vs. 36%) and allied health (10% vs. 4%) participants and a lower number of radiation therapists (17% vs. 32% ) compared to 2004.

Health professional preferences varied, with 7.5% and 3% judging IORT unacceptable at any risk, 18% and 21% judging IORT acceptable only if offering an equivalent risk, 56% and 59% judging IORT acceptable with a low maximum increase in risk (1-3%) and 19% and 17% judging a high maximum increase in risk acceptable (4-5%), in 2004 and 2011 respectively. A significantly greater number of nurses accepted IORT as a treatment option in 2011.

Conclusions

Most Western Australian health professionals working with breast cancer patients are willing to accept an increase in risk of local recurrence in order to replace EBRT with IORT in a hypothetical setting. This finding was consistent over two time points spanning 7 years despite the duration of clinical experience with IORT and the publication of the early clinical results of IORT in 2010. These results need to be compared with preferences elicited from patient groups, and further investigation into the impact of personal preferences on health professionals’ advice to patients is warranted.

【 授权许可】

   
2014 Corica et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Australian Institute of Health and Welfare: Breast cancer in Australia: an overview. In Cancer series no 71 Cat no CAN 67. Canberra: AIHW; 2012.
• [2]Fisher B, Bryant J, Dignam JJ, Wickerham D, Mamounas EP, Fisher ER, Margolese RG, Nesbitt L, Paik S, Pisansky TM, Wolmark N: Tamoxifen, radiation therapy, or both for prevention of ipsilateral breast tumor recurrence after lumpectomy in women with invasive breast cancers of one centimeter or less. J Clin Oncol 2002, 20:4141-4149.
• [3]Liljegren G, Holmberg L, Adami H-O, Westman G, Graffman S, Bergh J: Sector resection with or without postoperative radiotherapy for stage I breast cancer: five-year results of a randomized trial. J Natl Cancer Inst 1994, 86:717-722.
• [4]Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Harnett AN, Smith DC, George WD: Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Lancet 1996, 348:708-713.
• [5]Veronesi U, Marubini E, Mariani L, Galimberti V, Luini A, Veronesi P, Salvadori B, Zucali R: Radiotherapy after breast-conserving surgery in small breast carcinoma: long-term results of a randomized trial. Ann Oncol 2001, 12:997-1003.
• [6]Early Breast Cancer Trialists' Collaborative Group: Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005, 366:2087-2106.
• [7]Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sütterlin M, Esserman L, Holtveg HMR, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M: Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010, 376:91-102.
• [8]Jayant SV, Frederick W, Bulsara M, Tobias JS, Joseph D, Keshtgar M, Flyger H, Massarut S, Alvarado M, Saunders C, Eiermann W, Metaxas M, Sperk E, Sutterlin M, Brown D, Esserman L, Roncadin M, Thompson A, Dewar JA, Holtveg H, Pigorsch S, Falzon M, Harris E, Matthews A, Brew-Graves C, Potyka I, Corica T, Williams NR, Baum M: Updated results of local control and first analysis of survival from the randomised trial of risk-adapted TARGeted Intraoperative radioTherapy (TARGIT-A) for early breast cancer. Lancet 2013., 382Published online November 11
• [9]Keshtgar MS, Williams N, Bulsara M, Saunders C, Flyger H, Cardoso J, Corica T, Bentzon N, Michalopoulos N, Joseph D: Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Res Treat 2013, 140:519-525.
• [10]Hubbard G, Kidd L, Donagh E: Preferences for involvement in treatment decision making of patients with cancer: a review of the literature. Eur J Oncol Nurs 2008, 12:199-318.
• [11]Blinman P, Alam M, Duric V, McLachlan S-A, Stockler MR: Patients' Preferences for chemotherapy in non-small-cell lung cancer: a systematic review. Lung Cancer 2010, 69:141-147.
• [12]Blinman P, McLachlan SA, Nowak AK, Duric VM, Brown C, Wright G, Millward M, Fong K, Stockler MR: Lung cancer clinicians' preferences for adjuvant chemotherapy in non-small-cell lung cancer: what makes it worthwhile? Lung Cancer 2011, 72:213-218.
• [13]Blinman P, Duric V, Nowak AK, Beale P, Clarke S, Briscoe K, Boyce A, Goldstein D, Hudson M, Stockler M: Adjuvant chemotherapy for early colon cancer: what survival benefits make it worthwhile? Eur J Cancer 2010, 46:1800-1807.
• [14]Simes RJ, Coates AS: Patient preferences for adjuvant chemotherapy of early breast cancer: how much benefit is needed? J Natl Cancer Inst Monogr 2001, 30:146-152. Monographs
• [15]Stiggelbout AM, De Haes JCJM: Patient preference for cancer therapy: an overview of measurement approaches. J Clin Oncol 2001, 19:220-230.
• [16]Blinman P, King M, Norman R, Viney R, Stockler MR: Preferences for cancer treatments: an overview of methods and applications in oncology. Ann Oncol 2012, 23:1104-1110.
• [17]Fisher B, Anderson S, Redmond CK, Wolmark N, Wickerham DL, Cronin WM: Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995, 333:1456-1461.
• [18]Nguyen PL, Taghian AG, Katz MS, Niemierko A, Abi Raad RF, Boon WL, Bellon JR, Wong JS, Smith BL, Harris JR: Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 2008, 26:2373-2378.
• [19]Duric VM, Stockler MR, Heritier S, Boyle F, Beith J, Sullivan A, Wilcken N, Coates AS, Simes RJ: Patients' preferences for adjuvant chemotherapy in early breast cancer: what makes AC and CMF worthwhile now? Ann Oncol 2005, 16:1786-1794.
• [20]Whelan T, Levine M, Gafni A, Sanders K, Willan A, Mirsky D, Schnider D, McCready D, Reid S, Kobylecky A, Reed K: Mastectomy or Lumpectomy? Helping Women Make Informed Choices. J Clin Oncol 1999, 17:1727.
• [21]Hayman JA, Fairclough DL, Harris JR, Weeks JC: Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer. J Clin Oncol 1997, 15:1252-1260.
• [22]Palda VA, Llewellyn-Thomas HA, Mackenzie RG, Pritchard KI, Naylor CD: Breast cancer patients' attitudes about rationing postlumpectomy radiation therapy: applicability of trade-off methods to policy-making. J Clin Oncol 1997, 15:3192-3200.
• [23]Slevin ML, Stubbs L, Plant HJ, Wilson P, Gregory WM, Armes PJ, Downer SM: Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ (Clinical Research Ed) 1990, 300:1458-1460.
• [24]Bremnes RM, Andersen K, Wist EA: Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy. Eur J Cancer 1995, 31:1955-1959.
• [25]Corica T, Nowak A, Saunders C, Bulsara M, Joseph D: 482 Patient preferences for adjuvant radiotherapy in early breast cancer – an Australian sub-study of the international TARGIT trial. Eur J Cancer 2012, 48(Supplement 1):S187.
• [26]Asch DAJ, Kathryn M, Christakis , Nicholas A: Response rates to mail surveys published in medical journals. J Clin Epidemiol 1997, 50:1129-1136.
• [27]Duric V, Butow P, Sharpe L, Boyle F, Beith J, Wilcken N, Heritier S, Coates A, Simes R, Stockler M: Psychosocial factors and patients' preferences for adjuvant chemotherapy in early breast cancer. Psychooncology 2007, 16:48-59.
• [28]Cull W, O' Connor K, Sharp S, Tang S: Response rates and response bias for 50 surveys of pediatricians. Health Serv Res 2005, 40:213-226.
• [29]Alvarado M, Connolly JS, Oboite M, Park C, Esserman L: Patient preference for intra-operative (TARGIT) or external beam radiotherapy following breast conservation. Cancer Res 2010, 70(Supplement 24):P6-09-08.