Lack of Patient Compliance with Adjuvant Therapy Guidelines is an Important Risk Factor for Recurrence in Early Breast Cancer
Dennis Citrin, Sara Mortensen, James Grutsch and Rakshandra Neelam
World Journal of Psycho-Social Oncology 2013, 2:1
A retrospective three-year study identified 383 patients referred for treatment of recurrent breast cancer relapse, following previous primary treatment of early stage breast cancer. Details of their primary treatment were recorded to determine if their initial treatment complied with current National Comprehensive Cancer Network (NCCN) guidelines.
The original medical records of patients referred to Cancer Treatment Centers of America at Midwestern Regional Medical Center (CTCA/MRMC) with recurrent breast cancer were reviewed. Approval from our Institutional Review Board (IRB) was not required as this was a retrospective record review.
A total of 222 patients completed all treatment consistent with current NCCN guidelines, while 161 patients did not. 11 patients declined the recommended surgery, while 66 of the 299 patients refused the recommended radiation therapy. 354 patients received appropriate adjuvant chemotherapy. 74 patients either declined adjuvant chemotherapy or failed to complete the recommended course of chemotherapy treatment. Nearly forty percent of patients (102/261) either declined or terminated hormone treatment before receiving a full five years of therapy. Over 63% of the patients who were recommended adjuvant Herceptin (24/38) completed a full 12 months of treatment. Patients with negative nodes or 1-3 nodes involved were more likely to have received inadequate treatment when compared with those who had 4-9 or 10 or more nodes involved.
This study confirms that patients are more likely to refuse adjuvant drug treatment than surgery or radiation, and that refusal of treatment is associated with an increased risk of disease recurrence.