Radiotherapy Still Used in Some Older Breast Cancer Patients, In Spite of Little Benefit

“We were surprised by these results,” said lead author Cary P. Gross, MD, associate professor of internal medicine at Yale School of Medicine. “Clinical trials are considered the gold standard of medical research and in this case the trial was influential enough to lead to a change in treatment guidelines. We expected it to have more of an impact on clinical care at the bedside.”

The typical treatment course for older women with early stage breast cancer is breast-conserving surgery followed by radiation therapy. The purpose of added radiation therapy is to reduce recurrence of the disease. However, many older women have less aggressive tumors that put them at low risk for tumor recurrence.

The Yale investigators assessed the impact of a large research trial funded by the US National Cancer Institute (NCI; Bethesda, MD, USA) on clinical practice. Published in 2004, that NCI trial revealed that radiation therapy had only a small benefit for some women 70 and older with early stage, low-risk breast cancer. As a result of this study, breast cancer-treatment guidelines were changed to indicate that radiation therapy could be considered optional for such patients.

However, in the years following implementation of the new guidelines, Dr. Gross and his colleagues discovered that there has been minimal impact on the clinical care of older women with breast cancer. The team evaluated the use of radiation therapy among Medicare beneficiaries diagnosed with early stage breast cancer before and after the large NCI clinical trial was published. Approximately 79% of women received radiation before to the study compared with 75% after.

Even among the oldest women (85-94 years), the trial appeared to have little effect on clinician practice: The use of radiation decreased from 37% prior to the study to 33% after. “These findings have important implications for how the results of clinical research studies are translated into practice,” said Dr. Gross, who emphasized that the US government invested over USD 1 billion in comparative effectiveness research as part of the American Recovery and Reinvestment Act of 2009. “Our societal interest in funding this type of research is appropriate, and the need is great, but we must ensure that the results of such research extend beyond the journal page and are actually incorporated into clinical decision-making.”

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