SAN FRANCISCOThe rate of breast-conserving surgery with adjuvant
radiation therapy increased at a North Carolina community hospital (Durham
Regional) after Duke University Medical Center radiation oncologists opened an
on-site clinic. The study results were presented at the 43rd Annual Meeting of
the American Society for Therapeutic Radiology and Oncology (abstract 87).
During the period when the radiation oncology clinic was located 5 miles
from the community hospital, the rate of breast-conserving therapy was only
28.7%, said lead investigator Carol Hahn, MD, associate professor of radiation
oncology at Duke and chief of the Division of Radiation Oncology at Durham
Regional. After the radiation oncology clinic moved into the hospital, the
incidence of breast-conserving therapy shot up to 43.7%.
Previous studies have shown that the rate of breast-conserving therapy is
influenced by several variables, including patient age, insurance coverage, and
geographic location. Why do such nonmedical variables influence therapy for
breast conservation, the preferred treatment for many women with early breast
cancer? Dr. Hahn asked. "We had a change in practice setting that allowed
us to gain some insight into this," she said.
The researchers examined the community hospital’s pathology database to
compare treatment of 262 breast cancer patients during 1994-1995 when
radiotherapy was provided at Duke and 304 breast cancer patients during
1997-1998 after the move to the community hospital. Multivariate analysis
revealed that the incidence of breast-conserving therapy increased
significantly (P < .001) after the clinic moved on-site.
The incidence of breast-conserving therapy for patients with ductal
carcinoma in situ (DCIS) did not change during the study and was much higher
during both periods than for women with invasive cancer.
Dr. Hahn reported that the incidence of breast-conserving therapy in
patients with invasive disease increased from approximately 21% before the move
to 44% afterwards.