MedicalResearch.com Interview with:
Dr. Madhur Garg MD
Professor, Clinical director, Department of Radiation Oncology
Montefiore Einstein Center for Cancer Care
Albert Einstein College of Medicine.
Bronx, NY 10467
Medical Research: What is the background for this study? What are the main findings?
Dr. Garg: In most curative settings, external beam radiotherapy (RT) for the treatment of solid tumors is delivered five days each week over multiple weeks in an outpatient setting. Unintended treatment prolongation, generally attributed to treatment toxicity or inter-current illness, has been associated with inferior tumor control in a number of disease sites. Montefiore Einstein Center for Cancer Care recently identified radiotherapy (RT) noncompliance as a prevalent issue among patients receiving RT with curative intent. Approximately 20% of patients were deemed to be noncompliant, and statistically significant predictors of noncompliance risk included diagnosis, treatment course length, and socioeconomic status (SES). In this report, we examined if radiotherapy noncompliance is associated with clinical outcomes in our patient population.
In this analysis, we have found that treatment noncompliance is associated with inferior clinical outcomes for patients receiving radiotherapy with curative intent. The associations we detected were both statistically significant and clinically meaningful and consistent across disease sites. This is a novel finding that may have significant implications for how cancer care delivery can be improved, particularly in disadvantaged patient populations. Our finding that radiotherapy noncompliance is strongly associated with inferior outcomes, even after adjusting for confounders such as comorbidity index and SES, suggests to us that noncompliance may serve as a behavioral biomarker for other risk factors that contribute to poor outcomes. These may include noncompliance with other important clinician visits and procedures, lack of social support, and mood disorders.
Medical Research: What should clinicians and patients take away from your report?
Dr. Garg: Patients who miss treatments should receive careful follow up during treatments as they might require extra support. Interventions that improve patients’ overall adherence with recommended diagnostic, therapeutic, and follow-up procedures may help to address disparities in cancer outcomes. These might include patient navigation programs, management of mood disorders, and assistance with transportation.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Garg: Every cancer patient is different and deserves personalized care. Cancer treatment is generally long, involving seeing different doctors across several disciplines and patients might lose focus and give in to social, economic and psychological pressures. Continuous communication with the patient and their caregiver is the key to keeping their morale up and help them deal with the issues that come along.
Medical Research: Is there anything else you would like to add?
Dr. Garg: We are currently performing additional studies to determine the prevalence of these issues in our patient population and guide interventions that might improve our patients’ outcomes. We have put together a panel consisting of cancer patients, survivors, caregivers, and staff members to help identify ways to improve patient engagement and treatment adherence. Montefiore is also getting support from our Caregiver Support Cancer and colleagues in a cancer nutrition program and from those who specialize in psychosocial oncology at Montefiore and Einstein.
Dr. Madhur Garg MD (2016). Skipping Radiation Cancer Treatments Linked To Worse Outcomes