Radiation Therapy Noncompliance Impairs Tumor Control

A new study concludes that the interruption of sequential external beam radiation therapy (RT) appointments may impair tumor control, particularly for head and neck cancers.

Researchers at the Montefiore Einstein Center for Cancer Care (MECCC; New York, NY, USA) and Albert Einstein College of Medicine (New York, NY, USA) conducted a study that evaluated 1,227 patients between 2007 and 2012 who were scheduled for courses of external beam RT for cancers of the head and neck, breast, lung, cervix uterus, or rectum. In all, 21.7% of the patients were noncompliant, missing two or more scheduled therapy appointments, but all patients eventually completed the radiation therapy course planned for them.

The results showed that at median follow-up of 50.9 months, 108 recurrences (8.8%) and 228 deaths (18.6%) occurred. Despite the average one week delay in noncompliant patient RT completion, 16% of the noncompliant patients experienced a recurrence, versus only a 7% recurrence rate in compliant patients. According to the researchers, 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 was published in January 2016 issue of the International Journal of Radiation Oncology Biology Physics.

“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 senior author Prof. Madhur Garg, MD, clinical director of the department of Radiation Oncology at MECCC. “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.”

“We previously conducted a study that demonstrated a statistically significant relationship between lower socioeconomic status and non-compliance,” said lead author Nitin Ohri, MD, assistant professor of radiation oncology at Albert Einstein College of Medicine. “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.”

Prolonging radiation therapy for head and neck cancer or cervical cancer can impact tumor control and overall survival at a rate of one percent per day, which is attributed to tumor repopulation. The repopulation can even accelerate after treatment initiation.

Related Links:
Montefiore Einstein Center for Cancer Care
Albert Einstein College of Medicine