(Press-News.org) DURHAM, N.C. - Women over the age of 70 who have certain early-stage breast cancers overwhelmingly receive radiation therapy despite published evidence that the treatment has limited benefit, researchers at Duke Medicine report.
The study suggests that doctors and patients may find it difficult to withhold treatment previously considered standard of care, even in the setting of high quality data demonstrating that the advantages are small.
"The onus is on physicians to critically analyze data to shape our treatment recommendations for patients, weighing the potential toxicities of treatment against clinical benefit," said Rachel Blitzblau, M.D., Ph.D., the Butler Harris Assistant Professor of Radiation Oncology at Duke University Medical Center. Blitzblau was the senior author of a study published online Dec. 8, 2014, in the journal Cancer.
Blitzblau and colleagues launched their inquiry to determine whether clinical practice changed as a result of a large randomized, prospective study first published in 2004 that compared treatment options for women ages 70 and older with early-stage hormone-receptor positive breast cancers. The CALGB 9343 study reported limited benefit for adding radiation therapy plus the drug tamoxifen after lumpectomy among older women.
Specifically, the 2004 study's 5-year data showed a small but statistically significant reduction in the rate of cancer recurrence; a similar finding was reported again in 2012 with a decade of data. However, the addition of radiation to tamoxifen after surgery did not improve overall survival among the study participants at either of the reporting periods.
"The discussion at the time of the first CALGB report in 2004 was that we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs," Blitzblau said, adding that side effects include fatigue, discomfort and changes in the radiated breast tissue, among others.
But little has changed following publication of the study, with about two-thirds of women still getting radiation therapy. Blitzblau and colleagues analyzed cancer treatment patterns from a national health database called the Surveillance, Epidemiology, and End Results (SEER) registry. They found that before the CALGB study results were published in 2004, 68.6 percent of older women who would have been eligible for enrollment in the CALGB trial received radiation therapy. In the five years after the study was first reported, the rate dropped, but only slightly, to 61.7 percent.
"The publication of the trial had only a very small impact on practice patterns," Blitzblau said. "Our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care."
She said physicians might have delayed making practice changes until longer-term data was available; the research team's analysis did not include results after the 10-year data from CALGB was published in 2012. In addition, she said, there is likely lingering concern among both doctors and patients that reducing treatments may worsen outcomes for older women who have excellent overall health and therefore longer life expectancies.
But Blitzblau said the findings of the current study highlight an important and increasingly difficult challenge for physicians: Striking the right balance between offering effective treatments while also acknowledging the need for more financially efficient medical care.
"It's important to improve patient and doctor communication to ensure that the right patients are getting the right treatment at the right time," Blitzblau said. "As we work toward more efficient and evidence-based medical practice in all medical specialties, we will need to understand what processes may be needed to spur change."
INFORMATION:
In addition to Blitzblau, study authors include Manisha Palta, Priya Palta, Nrupen A. Bhavsar, and Janet K. Horton.
Dublin, IRELAND Monday December 8th, 2014 - Millions of documents stored in archives could provide scientists with the key to tracing agricultural development across the centuries, according to new research completed at Trinity College Dublin and the University of York.
Amazingly, thanks to increasingly progressive genetic sequencing techniques, the all-important historical tales these documents tell are no longer confined to their texts; now, vital information also comes from the DNA of the parchment on which they are written.
Researchers used these state-of-the-art ...
Metabolic syndrome is linked with an increased frequency and severity of lower urinary tract symptoms, but weight loss surgery may lessen these symptoms. The findings, which come from two studies published in BJU International, indicate that urinary problems may be added to the list of issues that can improve with efforts that address altered metabolism.
Lower urinary tract symptoms related to urinary frequency and urgency, bladder leakage, the need to urinate at night, and incomplete bladder emptying are associated with obesity in both men and women. To see if these ...
HANOVER, N.H. - December 8, 2014 - With health systems in the U.S., U.K., and around the world trying to increase vaccination levels, it is critical to understand how to address vaccine hesitancy and counter myths about vaccine safety. A new article in the journal "Vaccine" concludes, however, that correcting myths about vaccines may not be the most effective approach to promoting immunization among vaccine skeptics. The study, which was co-authored by Brendan Nyhan, an assistant professor of government at Dartmouth College, and Jason Reifler, a senior lecturer of politics ...
SAN FRANCISCO - The latest results of clinical trials of more than 125 patients testing an investigational personalized cellular therapy known as CTL019 will be presented by a University of Pennsylvania research team at the 56th American Society of Hematology Annual Meeting and Exposition. Highlights of the new trial results will include a response rate of more than 90 percent among pediatric acute lymphoblastic leukemia patients, and results from the first lymphoma trials testing the approach, including a 100 percent response rate among follicular lymphoma patients and ...
Although it is among the most highly metastatic of all cancers, multiple myeloma is driven to spread by only a subset of the myeloma cells within a patient's body, researchers at Dana-Farber Cancer Institute have found in a study presented at the annual meeting of the American Society of Hematology (ASH).
The study suggests that attacking those subsets with targeted drugs may degrade the disease's ability to spread throughout the bone marrow of affected patients, the authors say.
The discovery was made by developing a mouse model of the disease that enabled researchers ...
An oral targeted drug has shown encouraging activity and tolerable side effects in patients with treatment-resistant or relapsed acute myelogenous leukemia (AML) - a poor-prognosis group with few options - report investigators from Dana-Farber Cancer Institute and M.D. Anderson Cancer Center.
Of 32 patients treated with the oral inhibitor ABT-199, five had eradication of their leukemia and several more had stable disease, according to Anthony Letai, MD, PhD, of Dana-Farber, senior author of the report.
The phase 2 multicenter trial was the first ...
A phase two study that investigated the potential of the drugs azacitidine (AZA) and lenalidomide (LEN), demonstrated that the two therapies in combination may be an effective frontline treatment regimen for patients with higher-risk forms of myelodysplastic syndrome and acute myeloid leukemia.
Myelodysplastic syndrome (MDS) is a type of cancer in which the bone marrow does not make enough healthy blood cells, resulting in abnormal (blast) cells in the blood and/or bone marrow. Higher-risk patients experience an unusually large percentage of blasts in their blood. Patients ...
HOUSTON - (Dec. 7, 2014) - An international consortium of researchers led by Baylor College of Medicine has identified for the first time a gene associated with familial glioma (brain tumors that appear in two or more members of the same family) providing new support that certain people may be genetically predisposed to the disease.
"It is widely thought amongst the clinical community that there is no association between family history and development of glioma. Because we know very little about the contributing genetic factors, when cases occur in two or more family ...
Patients who relapse in their battle with acute myeloid leukemia (AML) may benefit from a phase three study of therapies that combine an existing agent, cytarabine, with a newer compound, vosaroxin.
The study, led by Farhad Ravandi, M.D, professor of medicine, department of leukemia at The University of Texas MD Anderson Cancer Center, demonstrated increased survival rates, particularly in AML patients over age 60.
Ravandi's study results were presented today at the 56th Annual Meeting of the American Society of Hematology (ASH) annual conference in San Francisco and ...
Results from a large, prospective clinical trial add to mounting evidence that adolescent and young adult patients--aged 16 to 39 with acute lymphoblastic leukemia (ALL)--tend to fare better when treated with high-intensity pediatric protocols than previous patients who were treated with standard adult regimens.
The intergroup trial, presented at the 56th annual meeting of the American Society of Hematology, enrolled 296 adolescent and young adult patients with ALL. All participants were treated by adult hematologists-oncologists on a pediatric protocol, including four ...
