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Doctors Are Slow To Adopt Changes In Breast Cancer Treatment

New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.

Cancer doctors want the best, most effective treatment for their patients. But it turns out many aren't paying attention to evidence that older women with early stage breast cancer may be enduring the pain, fatigue and cost of radiation treatment although it doesn't increase life expectancy.

Researchers from Duke University Medical Center analyzed the impact of a large randomized trial published in 2004 that compared treatment options for women over the age of 70 with early-stage breast cancer. That study compared cancer recurrence and survival rates among women who had surgery, chemotherapy and radiation to that of women who had surgery and chemotherapy only.

While there was a slight decrease in recurrence of cancer in the group who had radiation, there was no difference in survival, thus raising the question of whether radiation treatment for this group of patients is worthwhile.

According to Dr. Rachel Blitzblau, a radiation oncologist at Duke University Medical Center and lead author of the study, which was published Monday in the journal Cancer, "we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs."

Short-term side effects of radiation include skin blistering and fatigue. Long-term effects can include nerve damage and lymphedema, or swelling of the hand and arm.

Blitzblau and colleagues looked at practice patterns among cancer doctors, comparing the number of women who received radiation therapy prior to the 2004 findings and after. There was little difference, just a 7 percent drop in the number of women receiving radiation.

About 69 percent of patients treated between 2000 and 2004 got some form of radiation, compared with 62 percent 2005 and 2009.

"The publication of the trial had only a very small impact on practice patterns," she says, "our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care." The study was published Monday in the journal Cancer,

It may be that doctors are simply uncomfortable suggesting that patients forego treatment even when high quality studies show little advantage, Blitzblau says, adding that it's important to improve "evidence-based medical practice in all medical specialties."

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