TY - JOUR
T1 - Differences in Time Burden across Local Therapy Strategies for Early-stage Breast Cancer
AU - Swanick, Cameron W.
AU - Jiang, Jing
AU - Maldonado, J. Alberto
AU - Lei, Xiudong
AU - Shih, Ya Chen Tina
AU - Caudle, Abigail S.
AU - Baumann, Donald P.
AU - Giordano, Sharon H.
AU - Shaitelman, Simona F.
AU - Shirvani, Shervin M.
AU - Smith, Benjamin D.
N1 - Funding Information:
Disclosure: Dr. Smith is supported by the Andrew Sabin Family Fellowship. Portions of this work were supported by a research grant from Varian Medical Systems to Dr. Smith; a grant from the Cancer Prevention & Research Institute of Texas (Grant RP160674) to Drs. Smith and Giordano; and a grant from the National Institutes of Health to Drs. Smith and Shih (Grant R01CA207216). Dr. Shaitelman reports research funding from Elekta Incorporated that is unrelated to the current project. She is also a consultant to the MD Anderson Physician’s Network. This work was also supported by the Department of Health and Human Services National Cancer Institute (Grant P30CA016672), The Duncan Family Institute, and the Center for Radiation Oncology Research, and MD Anderson Cancer Center. These entities had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the article. All other authors have no financial interest to declare in relation to the content of this article.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/11/4
Y1 - 2021/11/4
N2 - Background: "Time burden" (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon). Methods: Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates. Results: Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon (P < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon (P < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days. Conclusions: Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.
AB - Background: "Time burden" (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon). Methods: Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates. Results: Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon (P < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon (P < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days. Conclusions: Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.
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U2 - 10.1097/GOX.0000000000003904
DO - 10.1097/GOX.0000000000003904
M3 - Article
C2 - 34745797
AN - SCOPUS:85163754538
SN - 2169-7574
VL - 9
SP - E3904
JO - Plastic and Reconstructive Surgery - Global Open
JF - Plastic and Reconstructive Surgery - Global Open
IS - 11
ER -