More than 75 percent of breast and colorectal cancer patients in southwest Georgia who prematurely stopped their prescribed chemotherapy did so in response to treatment side-effects or other clinical factors, according to a study by Emory University public health researchers.
Joseph Lipscomb, PhD, Emory Rollins School of Public Health professor of health policy and management and Georgia Cancer Coalition Distinguished Cancer Scholar, presented the findings of the study at the recent annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago.
The study focused on 1,152 patients who began treatment for breast or colorectal cancer between 2001 and 2003 in the 33-county region of southwest Georgia. The study is the first of several initiatives from the project, "Determinants of Patient Dropout from Cancer Treatment and Follow-up," funded by the U.S. Centers for Disease Control and Prevention (CDC).
While most instances of early treatment termination were attributable to adverse therapy and disease effects, an additional 20 percent were associated with a lack of transportation or social support or to other non-clinical factors, Dr. Lipscomb says.
Overall, about one-third of colorectal cancer patients and 15 percent of breast cancer patients in the study prematurely stopped their prescribed chemotherapy. The colorectal cancer treatment dropout rate was comparable with estimates from other studies of cancer care discontinuation, according to Dr. Lipscomb. However, the breast cancer dropout rate appeared to be lower than previously reported, he says.
"Cancer chemotherapy is highly effective in reducing the risk of early-stage breast and colorectal cancers recurring after initial removal by surgery. However, these drugs can be associated with multiple side effects, including diarrhea, low blood counts, nausea, vomiting and fatigue," says Dr. Lipscomb.
"Significant advances have been made in recent years in managing symptoms related to cancer treatment. Cancer patients should talk with their health care providers before and during treatment to identify ways to prevent or control symptoms related to cancer therapy," he added.
Among other key study findings:
- Married colorectal cancer patients were significantly more likely to complete treatment than patients who were single, divorced or separated.
- Among non-married breast cancer patients, older women and whites were more likely to discontinue chemotherapy for reasons other than completion.
- In all analyses undertaken, differences between white and non-white patients in terms of receiving and completing prescribed chemotherapy were either non-significant or in some cases suggested non-whites were more likely to complete their therapy compared to whites.
All findings were based on data abstracted from patient medical records in southwest Georgia, augmented by information from the Georgia Comprehensive Cancer Registry in Atlanta.
Future studies will examine cancer care discontinuation among lung and prostate cancer patients and look at dropout rates for other modes of therapy including radiation and hormonal treatment. The failure to complete care and its effect on patient survival also will be probed.
The study was co-authored by Theresa Gillespie, PhD, assistant professor of surgery in the Emory School of Medicine and director of health services research at the Atlanta Veterans Affairs Medical Center; Kevin Ward, MPH, deputy director of the Georgia Center for Cancer Statistics at Emory; and Michael Goodman, MD, assistant professor of epidemiology at the Rollins School of Public Health.
The project on cancer care discontinuation is a joint effort between Emory and the Southwest Georgia Cancer Coalition in cooperation with cancer treatment centers in Albany, Thomasville, Tifton and Valdosta. It is among severa l initiatives at Emory focusing on cancer prevention and control in the medically underserved southwest Georgia region through funding provided by the CDC to the Emory Prevention Research Center.