Medicare Patients Often Fail to Complete Radiation
for Head and Neck Cancer as Prescribed
Almost 40% had interruptions in radiation therapy
or failed to complete the course of therapy
Sept. 21, 2009 Medicare patients primarily
senior citizens commonly do not complete their prescribed radiation
therapy for head and neck cancer without interruptions, and many do not
complete the therapy at all, according to a report in the September
issue of Archives of OtolaryngologyHead & Neck Surgery, one of the JAMA/Archives
journals.
Patients who have surgery before radiation
treatment appear more likely to complete therapy, whereas those who have
other illnesses or who have chemotherapy first may be more likely to
experience interruptions or discontinuation in radiation treatment.
Head and neck cancers are a complex group of tumors
that involve the sinuses, lips, mouth, pharynx and larynx.
"Radiotherapy [radiation therapy] alone or as an
adjuvant to surgery and/or chemotherapy has been shown to be curative in
patients with local or regional head and neck cancers," the authors
write.
"Clinical evidence suggests that the radiation dose
and duration of treatment is correlated with tumor control and survival.
Breaks in radiotherapy have been associated with inferior tumor control
in the larynx, pharynx and oral cavity."
Megan Dann Fesinmeyer, Ph.D., M.P.H., of Fred
Hutchinson Cancer Research Center, Seattle, and colleagues used cancer
registries linked to Medicare data to identify 5,086 patients diagnosed
with head and neck cancer between 1997 and 2003. They then calculated
the timing and duration of radiotherapy using Medicare claims data, and
performed analyses to estimate the association between tumor and
clinical characteristics and any interruptions or discontinuation of
therapy.
A substantial percentage of patients (39.8 percent)
had interruptions in radiation therapy or failed to complete the course
of therapy.
Patients who had surgery at any tumor site were
more likely to complete radiotherapy with no interruptions (70.4
percent, vs. 52 percent of those who did not have surgery).
However, patients with co-occurring illnesses,
those who underwent chemotherapy and those whose disease had spread to
surrounding lymph nodes were less likely to do so.
"Surgical patients may be more likely to complete
radiotherapy for several reasons. First, characteristics that make
patients good candidates for surgery may also make them more likely to
complete radiotherapy. Because comorbidities are known to decrease
survival in patients with head and neck cancer, healthier patients may
be chosen by surgeons to complete more rigorous treatments (e.g.,
surgery in addition to radiotherapy)," the authors write.
"In addition, patients who are willing to undergo
major surgery to treat their disease may also be more motivated to
complete a full course of uninterrupted radiation therapy, despite any
toxic effects of treatment that may occur."
Further research is needed to understand the
factors associated with interruptions or failure to complete radiation
therapy among patients who do not have surgery, the authors conclude.
"Because chemotherapy appears to reduce the likelihood of completing
radiotherapy, future research is needed to identify specific agents,
doses and schedules that specifically reduce the likelihood of
completing treatment in community settings," they write.
This study was supported by an unrestricted
research grant from Amgen, Inc. Dr. Fesinmeyer reports ownership
interest in Amgen, Inc. Co-author Dr. Mehta reports having served as a
consultant for Amgen, Inc.
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Sept. 21, 2009 Medicare patients primarily
senior citizens commonly do not complete their prescribed radiation
therapy for head and neck cancer without interruptions, and many do not
complete the therapy at all, according to a report in the September
issue of Archives of OtolaryngologyHead & Neck Surgery, one of the JAMA/Archives
journals.
