Meeting NewsPerspective

Survey: Breast cancer radiation therapy ‘less scary’ than anticipated

Narek Shaverdian

More than 75% of women with breast cancer said radiation therapy, including short- and long-term side effects, was “less scary” than anticipated, according to a study presented at the American Society for Radiation Oncology Annual Meeting.

“Radiation itself is a frightening word, and there are data suggesting that patients are influenced by fears and misconceptions of radiation therapy,” Narek Shaverdian, MD, radiation oncology resident at the David Geffen School of Medicine at UCLA, told HemOnc Today. “However, over the last 20 years there have been significant advances in the way we deliver radiation therapy.

“We, therefore, wanted to look at the patients’ perspective of the modern breast cancer radiation experience, to have tangible real-world data to guide future patients and providers in their decision-making,” Shaverdian added.

Advances in radiation therapy technologies and the increased use of hypofractionation — in which radiation is given in larger doses over the course of fewer sessions — has afforded patients more convenient treatment options, as well as lower toxicity rates.

Large registry data also suggest that breast conservation may improve survival and breast cancer disease control compared with mastectomy, Shaverdian said.

“Despite this, more and more patients are electing for mastectomy, and there is an underuse of radiation therapy, even among patients treated with mastectomy with high-risk features, where radiation has shown to result in superior survival,” Shaverdian said.

Researchers sent surveys to 502 women who received treatment for breast cancer at UCLA-affiliated multidisciplinary breast cancer clinics between 2012 and 2016. All the women had at least 6 months of follow-up without cancer recurrence.

Sixty-five percent of patients (n = 327; median age, 59 years) returned the surveys.

Of those surveyed, 18% had stage 0 breast cancer, 38% stage I, 34% stage II and 9% stage III.

Eighty-two percent underwent breast conservation surgery, 70% received endocrine therapy, 37% received chemotherapy and 13% had axillary dissection. All women surveyed had received whole-breast radiotherapy with or without regional nodal coverage, hypofractionated whole-breast radiotherapy, postmastectomy radiotherapy or partial-breast radiotherapy.

Survey completion occurred a median of 31 months after completion of radiation therapy. Participants responded on whether the overall treatment experience and the short-term and long-term side effects were as, worse than or better than expected.

Nine in 10 patients found the experience of breast radiation therapy “less scary” than anticipated. Eighty-three percent reported the short-term side effects of radiation were as expected or better than they expected, and 84% reported the same about long-term side effects.

Women reported that side effects were less severe or as severe as expected for short-term fatigue (78%), breast pain (75%) and skin changes (61%), as well as for long-term appearance changes (85%), breast pain (79%), breast size changes (73%) and breast textural changes (70%).

“Our study shows that women who receive modern breast radiation therapy overwhelmingly found the treatment experience far better than expected,” Susan McCloskey, MD, MSHS, assistant professor at David Geffen School of Medicine at UCLA and director of breast service at UCLA Radiation Oncology, said in a press release. “The negative stories out there are frightening and pervasive, but they generally are not reflective of the actual experience.”

More than two-thirds (68%) of survey respondents reported they had little or no prior knowledge of radiation therapy at the time of their diagnosis, yet nearly half (47%) noted they had previously read or heard “frightening” stories of serious side effects from radiation therapy. Nearly all women surveyed (94%) responded that they were initially fearful of receiving radiation therapy because of concerns about damage to internal organs (40%), skin burning (24%) and becoming radioactive (7%).

“There are a lot of fears about radiation,” Shaverdian said during a press conference. “It might not be to the same degree as chemotherapy, but we do see it. Often, it may not be real — becoming radioactive is not a real fear of breast radiotherapy, but to patients it is.”

Only eight women (3%) agreed the negative stories they read about radiation therapy were true and six women (2%) agreed the negative stories heard from family and friends were true.

“If you Google breast radiation therapy and look at the image results, some of the first pictures you see are frightening images of red blisters, skin reactions that we rarely see,” Shaverdian said. “There have been a lot of advances in radiation therapy over the past 20 years — ways we are able to create an individualized radiation plan for each patient, and ways we are able to spread out the dosage and create a nice homogeneous plan. Sometimes, it is hard for people to appreciate these advances in technology that deliver outcomes in patients.”

Because of rapid advances in the field of radiation therapy, Shaverdian said not all physicians are “fully caught up” on its risks and benefits.

“We need to learn how to make sure patients are well informed before they make treatment decisions, and why a very small percentage of patients reported their toxicities to be more severe,” Shaverdian told HemOnc Today. “We need to continue to improve our treatments to minimize toxicities and improve the patient experience.” – by Chuck Gormley

Reference:

Shaverdian N, et al. Abstract 85. Presented at: American Society for Radiation Oncology Annual Meeting; Sept. 24-26, 2017; San Diego.

Disclosure : One researcher reports honoraria from Accuray.

Narek Shaverdian

More than 75% of women with breast cancer said radiation therapy, including short- and long-term side effects, was “less scary” than anticipated, according to a study presented at the American Society for Radiation Oncology Annual Meeting.

“Radiation itself is a frightening word, and there are data suggesting that patients are influenced by fears and misconceptions of radiation therapy,” Narek Shaverdian, MD, radiation oncology resident at the David Geffen School of Medicine at UCLA, told HemOnc Today. “However, over the last 20 years there have been significant advances in the way we deliver radiation therapy.

“We, therefore, wanted to look at the patients’ perspective of the modern breast cancer radiation experience, to have tangible real-world data to guide future patients and providers in their decision-making,” Shaverdian added.

Advances in radiation therapy technologies and the increased use of hypofractionation — in which radiation is given in larger doses over the course of fewer sessions — has afforded patients more convenient treatment options, as well as lower toxicity rates.

Large registry data also suggest that breast conservation may improve survival and breast cancer disease control compared with mastectomy, Shaverdian said.

“Despite this, more and more patients are electing for mastectomy, and there is an underuse of radiation therapy, even among patients treated with mastectomy with high-risk features, where radiation has shown to result in superior survival,” Shaverdian said.

Researchers sent surveys to 502 women who received treatment for breast cancer at UCLA-affiliated multidisciplinary breast cancer clinics between 2012 and 2016. All the women had at least 6 months of follow-up without cancer recurrence.

Sixty-five percent of patients (n = 327; median age, 59 years) returned the surveys.

Of those surveyed, 18% had stage 0 breast cancer, 38% stage I, 34% stage II and 9% stage III.

Eighty-two percent underwent breast conservation surgery, 70% received endocrine therapy, 37% received chemotherapy and 13% had axillary dissection. All women surveyed had received whole-breast radiotherapy with or without regional nodal coverage, hypofractionated whole-breast radiotherapy, postmastectomy radiotherapy or partial-breast radiotherapy.

Survey completion occurred a median of 31 months after completion of radiation therapy. Participants responded on whether the overall treatment experience and the short-term and long-term side effects were as, worse than or better than expected.

Nine in 10 patients found the experience of breast radiation therapy “less scary” than anticipated. Eighty-three percent reported the short-term side effects of radiation were as expected or better than they expected, and 84% reported the same about long-term side effects.

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Women reported that side effects were less severe or as severe as expected for short-term fatigue (78%), breast pain (75%) and skin changes (61%), as well as for long-term appearance changes (85%), breast pain (79%), breast size changes (73%) and breast textural changes (70%).

“Our study shows that women who receive modern breast radiation therapy overwhelmingly found the treatment experience far better than expected,” Susan McCloskey, MD, MSHS, assistant professor at David Geffen School of Medicine at UCLA and director of breast service at UCLA Radiation Oncology, said in a press release. “The negative stories out there are frightening and pervasive, but they generally are not reflective of the actual experience.”

More than two-thirds (68%) of survey respondents reported they had little or no prior knowledge of radiation therapy at the time of their diagnosis, yet nearly half (47%) noted they had previously read or heard “frightening” stories of serious side effects from radiation therapy. Nearly all women surveyed (94%) responded that they were initially fearful of receiving radiation therapy because of concerns about damage to internal organs (40%), skin burning (24%) and becoming radioactive (7%).

“There are a lot of fears about radiation,” Shaverdian said during a press conference. “It might not be to the same degree as chemotherapy, but we do see it. Often, it may not be real — becoming radioactive is not a real fear of breast radiotherapy, but to patients it is.”

Only eight women (3%) agreed the negative stories they read about radiation therapy were true and six women (2%) agreed the negative stories heard from family and friends were true.

“If you Google breast radiation therapy and look at the image results, some of the first pictures you see are frightening images of red blisters, skin reactions that we rarely see,” Shaverdian said. “There have been a lot of advances in radiation therapy over the past 20 years — ways we are able to create an individualized radiation plan for each patient, and ways we are able to spread out the dosage and create a nice homogeneous plan. Sometimes, it is hard for people to appreciate these advances in technology that deliver outcomes in patients.”

Because of rapid advances in the field of radiation therapy, Shaverdian said not all physicians are “fully caught up” on its risks and benefits.

“We need to learn how to make sure patients are well informed before they make treatment decisions, and why a very small percentage of patients reported their toxicities to be more severe,” Shaverdian told HemOnc Today. “We need to continue to improve our treatments to minimize toxicities and improve the patient experience.” – by Chuck Gormley

Reference:

Shaverdian N, et al. Abstract 85. Presented at: American Society for Radiation Oncology Annual Meeting; Sept. 24-26, 2017; San Diego.

Disclosure : One researcher reports honoraria from Accuray.

    Perspective
    Reshma Jagsi, MD, DPhil

    Reshma Jagsi

    This study is especially timely because there are growing concerns about rising rates of mastectomy among women who could safely receive a much more limited lumpectomy surgery to treat their breast cancer. For some women, fear of radiation leads them to choose a much more aggressive surgery, often followed by breast reconstruction, increasing the risk for complications and protracting the time they spend in the operating room, healing and recovery. The rigorously collected evidence from patients' own survey responses — indicating that the vast majority agree that radiation therapy is not as scary as they had anticipated — is invaluable for future patients who face a dizzying array of options for breast cancer treatment and seek to make a truly informed decision.

    • Reshma Jagsi, MD, DPhil
    • University of Michigan

    Disclosures: Jagsi reports research funding from American Cancer Society, Breast Cancer Research Foundation, National Comprehensive Cancer Network and NIH.

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