Search

Purpose: Socioeconomic barriers contribute to breast cancer clinical trial enrollment disparities. We sought to identify whether socioeconomic disadvantage also is associated with decreased trial retention., Methods and Materials: We performed a secondary analysis of 253 (of 287) patients enrolled in a randomized phase 3 trial of conventionally fractionated versus hypofractionated whole-breast irradiation. The outcome of trial retention versus dropout was defined primarily based on whether the patient completed breast cosmesis outcomes assessment at 3-year follow-up, and secondarily, at 5-year follow-up. Associations of retention with severity of socioeconomic disadvantage, quantified by patients' home neighborhood area deprivation index (ADI) rank (1 [least] to 100 [most deprivation]), were tested using the Kruskal-Wallis test and multivariate logistic regression. Associations of retention with patients' use of social resource assistance were analyzed using the χ 2 test., Results: In total, 21.7% (n = 55) of patients dropped out by 3 years and 36.7% (n = 92) by 5 years. Median ADI was 36.5 (interquartile range, 22-57) for retained and 46.0 (interquartile range, 29-60) for dropout patients. Dropout was associated with more severe socioeconomic deprivation (ADI ≥45 vs <45) at 3 years (odds ratio, 3.63; 95% confidence interval, 1.62-8.15; P = .002) and 5 years (odds ratio, 2.55; 95% confidence interval, 1.37-4.76; P = .003). While on study, patients who ultimately dropped out were more likely to require resource assistance for practical (transportation, housing, financial) than psychological needs (distress, grief) or advance care planning (P = .03)., Conclusions: In this study, ADI was associated with disparities in clinical trial retention of patients with breast cancer receiving adjuvant radiation treatment. Results suggest that developing multidimensional interventions that extend beyond routine social determinants needs screening are needed, not only to enhance initial clinical trial access and enrollment but also to enable robust long-term retention of socioeconomically disadvantaged patients and improve the validity and generalizability of reported long-term trial clinical and patient-reported outcomes., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Using evidence-based radiation therapy to direct care for patients with breast cancer is critical to standardize practice, improve safety, and optimize outcomes. To address this need, the Veterans Affairs (VA) National Radiation Oncology Program (NROP) established the VA Radiation Oncology Quality Surveillance Program to develop clinical quality measures (QMs). The VA NROP contracted with the American Society for Radiation Oncology to commission 5 Blue Ribbon Panels for breast, lung, prostate, rectal, and head and neck cancers., Methods and Materials: The Breast Cancer Blue Ribbon Panel experts worked collaboratively with the NROP to develop consensus QMs for use throughout the VA system, establishing a set of QMs for patients in several areas, including consultation and work-up; simulation, treatment planning, and treatment; and follow-up care. As part of this initiative, consensus dose-volume histogram (DVH) constraints were outlined., Results: In total, 36 QMs were established. Herein, we review the process used to develop QMs and final consensus QMs pertaining to all aspects of radiation patient care, as well as DVH constraints., Conclusions: The QMs and expert consensus DVH constraints are intended for ongoing quality surveillance within the VA system and centers providing community care for Veterans. They are also available for use by greater non-VA community measures of quality care for patients with breast cancer receiving radiation., (Published by Elsevier Inc.)

Competing Interests: MAC reports a consultancy role with Beigene, EUSA Pharma, Celgene-BMS, Kite-Gilead, Janssen, Incyte, Karyopharm, Kyowa, Novartis, F. Hoffmann-La Roche Ltd., Sanofi, and Takeda, and honoraria from EUSA Pharma, Celgene-BMS, Kite-Gilead, Janssen, Kyowa, F. Hoffmann-La Roche Ltd., Sandoz, and Takeda. TAB reports a leadership role and is a stockholder of Nucleix and Empyrean Medical Systems, honoraria from Genentech, Inc., F. Hoffmann-La Roche Ltd., Abivax, and Precisa, a consulting or advisory role with Genentech, Inc. and F. Hoffmann-La Roche Ltd., patents, royalties, and other intellectual property with MD Anderson Cancer Center, and travel, accommodations, and expenses from Genentech, Inc. JAPB, LMF, and TI, report no conflicts. KI reports honoraria from Chugai Pharmaceutical, AbbVie, AstraZeneca, Daiichi Sankyo, Genmab, Kyowa Kirin, Novartis, Ono Pharmaceutical, Symbio, and Takeda and research funding from Chugai Pharmaceutical and Eisai. AS reports a consultancy role with Janssen, EUSA Pharma, BMS, Celgene, and Beigene, research funding from AbbVie, and a speaker’s bureau role for Janssen, BMS, and Celgene. JPS owns stock options with Centessa Pharmaceuticals, consultancy with AbbVie, AstraZeneca, Beigene, Bristol Myers Squibb, Lilly, Pharmacyclics, TG Therapeutics and Genentech, Inc., and membership on board of directors or advisory committees for Centessa Pharmaceuticals. DK reports employment with F. Hoffmann-La Roche Ltd and Celegene, and is a stockholder of F. Hoffmann-La Roche Ltd. JP reports employment with F. Hoffmann-La Roche Ltd and is a stockholder of F. Hoffmann-La Roche Ltd. SP reports employment with F. Hoffmann-La Roche Ltd. EV reports employment with IQVIA. PT reports employment with Genentech, Inc. and is a stockholder of F. Hoffmann-La Roche Ltd. KH reports employment with University of Cologne, a consultancy role with F. Hoffmann-La Roche Ltd., research funding from F. Hoffmann-La Roche Ltd., Celgene, BMS, and Janssen, honoraria from F. Hoffmann-La Roche Ltd., Servier, Gilead, Celgene, BMS, and EUSA Pharma, a speaker’s bureau role for F. Hoffmann-La Roche Ltd., Servier, Celgene, BMS, and EUSA Pharma, membership on an entity’s Board of Directors or advisory committees for F. Hoffmann-La Roche Ltd., Hexal, Novartis, Gilead, and Incyte.

Purpose: Ensuring high quality, evidence-based radiation therapy for patients is of the upmost importance. As a part of the largest integrated health system in America, the Department of Veterans Affairs National Radiation Oncology Program (VA-NROP) established a quality surveillance initiative to address the challenge and necessity of providing the highest quality of care for veterans treated for cancer., Methods and Materials: As part of this initiative, the VA-NROP contracted with the American Society for Radiation Oncology to commission 5 Blue Ribbon Panels for lung, prostate, rectal, breast, and head and neck cancers experts. This group worked collaboratively with the VA-NROP to develop consensus quality measures. In addition to the site-specific measures, an additional Blue Ribbon Panel comprised of the chairs and other members of the disease sites was formed to create 18 harmonized quality measures for all 5 sites (13 quality, 4 surveillance, and 1 aspirational)., Conclusions: The VA-NROP and American Society for Radiation Oncology collaboration have created quality measures spanning 5 disease sites to help improve patient outcomes. These will be used for the ongoing quality surveillance of veterans receiving radiation therapy through the VA and its community partners., (Published by Elsevier Inc.)