Adjuvant radiation and outcomes after breast conserving surgery in publicly insured patients

Gretchen G. Kimmick, Fabian Camacho, Wenke Hwang, Heath Mackley, John Stewart, Roger T. Anderson

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)138-146
Number of pages9
JournalJournal of Geriatric Oncology
Volume3
Issue number2
DOIs
StatePublished - Apr 1 2012

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Segmental Mastectomy
Radiation
Mortality
Breast Neoplasms
Recurrence
Comorbidity
Logistic Models
Papanicolaou Test
Preventive Medicine
Insurance Coverage
Mammography
Adjuvant Chemotherapy
Epidemiologic Studies
Primary Health Care
Hospitalization
Multivariate Analysis
Hormones

All Science Journal Classification (ASJC) codes

  • Oncology
  • Geriatrics and Gerontology

Cite this

Kimmick, Gretchen G. ; Camacho, Fabian ; Hwang, Wenke ; Mackley, Heath ; Stewart, John ; Anderson, Roger T. / Adjuvant radiation and outcomes after breast conserving surgery in publicly insured patients. In: Journal of Geriatric Oncology. 2012 ; Vol. 3, No. 2. pp. 138-146.
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abstract = "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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Adjuvant radiation and outcomes after breast conserving surgery in publicly insured patients. / Kimmick, Gretchen G.; Camacho, Fabian; Hwang, Wenke; Mackley, Heath; Stewart, John; Anderson, Roger T.

In: Journal of Geriatric Oncology, Vol. 3, No. 2, 01.04.2012, p. 138-146.

Research output: Contribution to journalArticle

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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.

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