New study finds interruption of radiation therapy risks cancer recurrence
February 9, 2016–(NEW YORK, NY)–Cancer patients who miss two or more radiation therapy sessions have a worse outcome than fully compliant patients, investigators at Montefiore Einstein Center for Cancer Care (MECCC) and Albert Einstein College of Medicine's NCI-designated Albert Einstein Cancer Center have found. The study, published in the International Journal of Radiation Oncology Biology Physics, suggests that this noncompliance to scheduled treatments may represent a new behavioral biomarker for identifying high-risk patients who require additional interventions to achieve optimal care outcomes.
The study evaluated 1,227 patients scheduled for courses of external beam radiation therapy for cancers of the head and neck, breast, lung, cervix uterus or rectum from 2007 to 2012. Two hundred twenty six of these patients (22 percent) were noncompliant (i.e., they missed two or more scheduled radiation therapy appointments). All patients eventually completed the radiation therapy course planned for them.
The radiation therapy course for noncompliant patients was prolonged for an average of one week compared with compliant patients. Nevertheless, 16 percent of noncompliant patients later experienced a recurrence of their cancers versus only a 7 percent recurrence rate for compliant patients.
"This study shows that the health of our patients can improve only when a course of treatment is completed in the prescribed period of time," said Madhur Garg, M.D., clinical director, Department of Radiation Oncology, MECCC and professor of clinical radiation oncology at Einstein. "These findings should serve as a wakeup call to physicians, patients and their caregivers about the critical need to adhere to a recommended treatment schedule."
Prolonging radiation therapy for head and neck cancer or cervical cancer impacted tumor control and overall survival at the greatest rate, at one percent per day, however this negative impact was seen in all cancers studied. This is attributed to tumor repopulation, which can accelerate after treatment initiation.
"We previously conducted a study that demonstrated a statistically significant relationship between lower socioeconomic status and non-compliance," said Nitin Ohri, M.D., attending physician, MECCC and assistant professor of radiation oncology at Einstein. "A Multivariable Cox proportional hazard model was informed by this prior study and helped us adjust for demographic variables like age, race, ethnicity and socioeconomic status."
As an outcome result of this study, management of mood disorders, patient navigator programs and increasing assistance with transportation are being evaluated at Montefiore as interventions that might improve patient care outcomes and close disparities among vulnerable populations.
About Montefiore Health System
Montefiore Health System is a premier academic health system and the University Hospital for Albert Einstein College of Medicine. Combining nationally-recognized clinical excellence with a population health perspective that focuses on the comprehensive needs of the communities it serves, Montefiore delivers coordinated, compassionate, science-driven care where, when and how patients need it most. Montefiore consists of eight hospitals and an extended care facility with a total of 2,747 beds, a School of Nursing, and state-of-the-art primary and specialty care provided through a network of more than 150 locations across the region, including the largest school health program in the nation and a home health program. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals." Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The health system derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit http://www.montefiore.org. Follow us on Twitter; like us on Facebook; view us on YouTube.
Albert Einstein College of Medicine is one of the nation's premier centers for research, medical education and clinical investigation. During the 2015-2016 academic year, Einstein is home to 731 M.D. students, 193 Ph.D. students, 106 students in the combined M.D./Ph.D. program, and 278 postdoctoral research fellows. The College of Medicine has more than 1,900 full-time faculty members located on the main campus and at its clinical affiliates. In 2015, Einstein received $148 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center–Einstein's founding hospital, and three other hospital systems in the Bronx, Brooklyn and on Long Island, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit http://www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.