Trends in Postmastectomy Therapy, Breast Reconstruction Linked to NCCN Guideline Changes

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New changes in the National Comprehensive Cancer Network Guidelines (NCCN) could indicate increasing physician comfort.
New changes in the National Comprehensive Cancer Network Guidelines (NCCN) could indicate increasing physician comfort.

New changes in the National Comprehensive Cancer Network Guidelines (NCCN) could indicate increasing physician comfort with irradiating a new breast reconstruction that could have cosmetic and quality of life effects on patients.

The changes were associated with an increase in postmastectomy radiation therapy (PMRT) in patients whose tumors were 5 cm or less, and had 1 to 3 positive lymph nodes.

Emerging data regarding the effectiveness of PMRT prompted the NCCN to change its recommendations, counseling clinicians to “strongly consider” PMRT for patients with breast cancer whose tumors were 5 cm or smaller, and had 1 to 3 positive lymph nodes. Prior to the changes, anticipation of PMRT might delay or cause omission of breast reconstruction, having a profound quality of life effects on patients.

Researchers sought to determine the effect the revised guidelines had on PMRT rates and whether receipt of breast reconstruction would decrease in these women while increasing in other groups.

Researchers performed a retrospective, population-based cohort study of Surveillance, Epidemiology, and End Results (SEER) data on women with stage 1 to 3 breast cancer who underwent mastectomy from 2000 to 2011. They divided the sample into 3 cohorts “radiotherapy recommended” (n = 15 999), “strongly consider radiotherapy,” (n = 15 006) and “radiotherapy not recommended,” (n = 31 837).

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Results showed that rates remained unchanged in the radiotherapy recommended group (29.9%) and radiotherapy not recommended (7.4%) group during the study period.

The strongly consider radiotherapy group remained the same (26.9%) until 2007, when a significant change in the APC was observed (P = .01). It increased from 2.1% to 9.0% (P = .02) through the end of the study period, and ended at 40.5%. All groups had higher rates of breast reconstruction (annual percentage increase 7.4%). These results were similar in the radiotherapy recommended (10.7%) and radiotherapy not recommended group (8.4%).

Reference

  1. Frasier LL, Holden, S, Holden T, et el. Temporal trends in postmastectomy radiation therapy and breast reconstruction associated with changes in National Comprehensive Cancer Network Guidelines [ published online ahead of print November 5, 2015]. JAMA Oncology. doi: 10.1001/jamaoncol.2015.3717. 

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