Missing two or more radiation therapy sessions can have severe adverse effects on clinical outcomes, according to a new study.
Noncompliance with treatment schedules is a critical issue for many patient populations but especially for patients being treated for cancer. Researchers from Montefiore Einstein Center for Cancer (Bronx, NY) reviewed the effects of skipping scheduled radiation therapy sessions for patients with cancers of the head and neck, breast, lung, cervix, uterus, or rectum. The study was published in the International Journal of Radiation Oncology, Biology, Physics.
Medical records of 1227 patients being treated for cancer were reviewed for the study. All had scheduled courses of radiation therapy between 2007 and 2012. Although all patients completed the planned courses of therapy, 266 patients (21%) were considered noncompliant, meaning that they missed two or more radiation therapy sessions. Compared with compliant patients, patients deemed noncompliant had an increased recurrence risk (16% vs 7%), a worse rate of recurrence-free survival (63% vs 79%), and a worse rate of overall survival (72% vs 83%). These findings were confirmed after adjusting for factors such as disease site and state, comorbidity score, gender, ethnicity, race and socioeconomic status.
Overall, missing scheduled radiation treatments had a negative impact on outcomes across all cancer types, but most significantly for patients with head and neck or cervical cancer. This was most likely attributable to tumor repopulation, which can accelerate after treatment in these disease sites.
Lead author, Nitin Ohri, MD, assistant professor of radiation at Einstein and coauthors concluded that noncompliance with radiation treatment schedules was associated with inferior clinical outcomes in patients with cancer and therefore may serve as a behavioral biomarker for high-risk patients in need of additional interventions. Researchers are continuing to investigate how the management of mood disorders, patient navigator programs, and increasing access to transportation might improve treatment compliance among patients with cancer.
