Radiation Oncologists Often Excluded From Breast Cancer Treatment Decisions

Nearly half the surgeons acknowledged that few or none of the patients with breast cancer whom they had treated in the last 12 months had consulted with a radiation oncologist before undergoing definitive surgery.

A “substantial minority” of radiation oncologists report that surgeons fail to include them in the breast cancer treatment decision-making process before definitive surgery, according to survey results. As a result, patients may decide on a treatment without being aware of all of their options, resulting in more mastectomies in lieu of breast-conserving therapy.

Reshma Jagsi, MD, associate professor of Radiation Oncology at the University of Michigan in Ann Arbor, and colleagues analyzed the results of questionnaires completed by 160 radiation oncologists and 318 attending surgeons who are responsible for the locoregional management of breast cancer. Physicians participating in the survey treated patients in the metropolitan areas of Detroit, Michigan, and Los Angeles, California.

While patients with newly diagnosed breast cancer routinely consult surgeons, little is known about the frequency and timing of consultation with radiation oncologists, the researchers pointed out.

In their study, they aimed to determine when radiation oncologists become involved in the management of patients newly diagnosed with breast cancer, and whether radiation oncologists and surgeons have different opinions about what constitutes the optimal management of these patients.

The authors also examined the coordination of care between these specialists.

Overall, 92.1% of surgeons and 94.8% of radiation oncologists reported that they had access to a multidisciplinary tumor board where different specialists discussed the plan for cancer patients before making treatment decisions. Even so, 27.9% of radiation oncologists said that other providers failed to include them in the treatment decision process early enough.

Surgeons and radiation oncologists differed in their recommendations on how best to manage some common breast cancer scenarios. For example, radiation oncologists were more likely to prefer the use of radiotherapy than were surgeons for a patient with 3/20 lymph nodes undergoing mastectomy (P = .03). In a scenario t hat asked about margin width in the setting of breast conservation, surgeons were more likely to favor more widely clear surgical margins than were radiation oncologists (P = .001).

“The finding of systematic differences between radiation oncologists and surgeons in their attitudes toward locoregional management approaches suggests that the observed relative lack of early participation of radiation oncologists may be important for some patient groups, particularly those who are undecided about their choice of local therapy or those who have concerns about the side effects of radiation therapy,” the authors wrote.

Jagsi R, Abrahamse P, Morrow M, et al. Coordination of breast cancer care between radiation oncologists and surgeons: a survey study. Int J Radiat Oncol Biol Phys. 2012;82(5):2072-2078.