Ohri Nitin, Rapkin Bruce D, Guha Chandan, Kalnicki Shalom, Garg Madhur
Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Department of Epidemiology and Population Health, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Int J Radiat Oncol Biol Phys. 2016 Jun 1;95(2):563-70. doi: 10.1016/j.ijrobp.2016.01.043. Epub 2016 Jan 30.
To examine associations between radiation therapy (RT) noncompliance and clinical outcomes.
We reviewed all patients who completed courses of external beam RT with curative intent in our department from the years 2007 to 2012 for cancers of the head and neck, breast, lung, cervix, uterus, or rectum. Patients who missed 2 or more scheduled RT appointments (excluding planned treatment breaks) were deemed noncompliant. Univariate, multivariable, and propensity-matched analyses were performed to examine associations between RT noncompliance and clinical outcomes.
Of 1227 patients, 266 (21.7%) were noncompliant. With median follow-up of 50.9 months, 108 recurrences (8.8%) and 228 deaths (18.6%) occurred. In univariate analyses, RT noncompliance was associated with increased recurrence risk (5-year cumulative incidence 16% vs 7%, P<.001), inferior recurrence-free survival (5-year actuarial rate 63% vs 79%, P<.001), and inferior overall survival (5-year actuarial rate 72% vs 83%, P<.001). In multivariable analyses that were adjusted for disease site and stage, comorbidity score, gender, ethnicity, race, and socioeconomic status (SES), RT noncompliance was associated with inferior recurrence, recurrence-free survival, and overall survival rates. Propensity score-matched models yielded results nearly identical to those seen in univariate analyses. Low SES was associated with RT noncompliance and was associated with inferior clinical outcomes in univariate analyses, but SES was not associated with inferior outcomes in multivariable models.
For cancer patients being treated with curative intent, RT noncompliance is associated with inferior clinical outcomes. The magnitudes of these effects demonstrate that RT noncompliance can serve as a behavioral biomarker to identify high-risk patients who require additional interventions. Treatment compliance may mediate the associations that have been observed linking SES and clinical outcomes.
探讨放射治疗（RT）不依从性与临床结局之间的关联。
我们回顾了2007年至2012年期间在我科接受根治性外照射放疗的所有患者，这些患者患有头颈部、乳腺、肺、宫颈、子宫或直肠癌。错过2次或更多预定放疗预约（不包括计划中的治疗中断）的患者被视为不依从。进行单因素、多因素和倾向匹配分析，以研究RT不依从性与临床结局之间的关联。
在1227例患者中，266例（21.7%）不依从。中位随访50.9个月，发生108例复发（8.8%）和228例死亡（18.6%）。在单因素分析中，RT不依从性与复发风险增加相关（5年累积发病率16%对7%，P<0.001）、无复发生存期较差（5年精算率63%对79%，P<0.001）以及总生存期较差（5年精算率72%对83%，P<0.001）。在针对疾病部位和分期、合并症评分、性别、种族、民族和社会经济地位（SES）进行调整的多因素分析中，RT不依从性与较差的复发率、无复发生存率和总生存率相关。倾向评分匹配模型得出的结果与单因素分析中所见结果几乎相同。低SES与RT不依从性相关，并且在单因素分析中与较差的临床结局相关，但在多因素模型中SES与较差的结局无关。
对于接受根治性治疗的癌症患者，RT不依从性与较差的临床结局相关。这些影响的程度表明，RT不依从性可作为一种行为生物标志物，用于识别需要额外干预的高危患者。治疗依从性可能介导了已观察到的将SES与临床结局联系起来的关联。
