Attitudes of Canadian Radiation Oncologists towards Post-lumpectomy Radiotherapy for Elderly Women with Stage I Hormone-responsive Breast Cancer

Warner, E.; Chow, E.; Fairchild, A.; Franssen, E.; Paszat, L.; Szumacher, E.

doi:10.1016/j.clon.2009.10.001

« Previous Next »Clinical Oncology
Volume 22, Issue 2 , Pages 97-106, March 2010

Attitudes of Canadian Radiation Oncologists towards Post-lumpectomy Radiotherapy for Elderly Women with Stage I Hormone-responsive Breast Cancer

E. Warner
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
E. Chow
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
A. Fairchild
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
E. Franssen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta, Canada
- Faculty of Medicine, University of Toronto, Canada
L. Paszat
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
E. Szumacher
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
- Author for correspondence: E. Szumacher, Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, M4N3M5, Canada. Tel: +416-480-4834; Fax: +416-480-6002.

Received 13 March 2009; received in revised form 9 September 2009; accepted 1 October 2009.

Abstract

Aims

Post-lumpectomy breast radiation is the standard of care for all patient subgroups. However, elderly women with stage I breast cancer on adjuvant tamoxifen therapy have a 4% risk of local recurrence after lumpectomy without adjuvant breast radiation. The purpose of this study was to explore the attitudes of Canadian radiation oncologists who treat breast cancer with respect to their use of adjuvant post-lumpectomy radiotherapy, and their willingness to implement a decision aid for this patient population.

Materials and methods

The questionnaire was mailed to 141 Canadian radiation oncologists who treat breast cancer. The respondents were asked to complete an online survey consisting of four parts: (1) demographic information; (2) factors determining post-lumpectomy radiation treatment decisions; (3) hypothetical case scenarios; (4) interest in using a decision aid in their practice.

Results

Among the 61 (43%) physicians who completed the survey, there was substantial response variation. After contraindications to radiotherapy, patient overall health and patient preference had the greatest influence on their decision to offer radiotherapy to this patient subgroup. Margin status and use of hormonal therapy were given less importance. For each of the case scenarios, 60–83% of physicians (depending on the case scenario) would offer the patient a choice; far fewer (12–57%) would be comfortable not irradiating. Sixty-four per cent of respondents welcomed the concept of a decision aid for this population.

Conclusions

Although there is significant variation in practice patterns and attitudes among radiation oncologists regarding post-lumpectomy radiotherapy for elderly, low-risk breast cancer patients, the vast majority value patient choice and would be willing to use a decision aid designed for this population in their practice.

Key words: Adjuvant, breast cancer, radiotherapy