Study: Three-Part Treatment Underused in Treating Inflammatory Breast Cancer
An analysis of data on more than 10,000 women with inflammatory breast cancer looked at the use of trimodality treatment, in which three treatment types (surgery, chemotherapy and radiation therapy) are used. The study found that women who had this type of therapy lived longer than women who did not.
Background and Goals
Inflammatory breast cancer, IBC, is a rare and fast-growing form of the disease in which breast cancer cells block vessels in the skin of the breast. This causes the affected breast to look red and swollen and feel warm. Experts believe that IBC represents about 1 to 5 percent of breast cancer cases in the United States.
The National Comprehensive Cancer Network has guidelines recommending trimodality treatment be used for IBC. However, few studies have looked at how well those guidelines are followed and what the outcomes are for those with IBC.
To learn more, researchers used the National Cancer Data Base, NCDB, which collects information from about 1,450 Commission on Cancer-approved hospitals throughout the U.S. and looks at local, regional and national trends. The NCDB is estimated to include information about 70 percent of new cancer diagnoses in the country every year.
Researchers used the NCDB to identify women who had surgery to treat IBC from 1998 to 2010. Women who had any kind of cancer diagnosis in the past or who had metastatic breast cancer, breast cancer that spread to another part of the body, were excluded.
The team identified 10,197 eligible women, and divided them into the following four groups, based on what treatment they received:
- surgery only
- surgery plus chemotherapy
- surgery plus radiation therapy
- surgery, radiation therapy and chemotherapy (trimodality treatment)
The researchers then looked at overall survival, OS, the time from start of treatment until death from any cause, and 5- and 10-year survival rates.
- was given to 66.8 percent of women overall, making it the most popular treatment
- was used to treat between 58.4 percent and 73.4 percent of the women in any given year, with use peaking in 2004
- was associated with median OS of 72 months, versus a median of 61 months for all women in the study
Five-year survival rates were 55.4 percent in the trimodality group, the highest of all four treatment groups. Trimodality also had the highest 10-year survival rate, at 37.3 percent.
The three-part treatment was more likely to be used in women who
- were younger
- were diagnosed closer to 2010 than 1998
- were treated in the Great Lakes, Midwest or Northeast
- had private insurance or few other medical issues.
Being white, young, in good general health and having private insurance was associated with longer OS.
According to the researchers, an “alarming” number of women did not have radiation therapy, including the 26.8 percent who received only surgery and chemotherapy. Adding the radiation therapy to this group would have turned their therapy into trimodality treatment.
Women with lower incomes and public health insurance were less likely to get the treatment.
Past research has shown that treating IBC with a combination of taxane- and anthracycline-based chemotherapies can lead to better survival. The data these researchers used did not identify which type of chemotherapy was given to each woman, so the impact that these different treatments had on OS could not be determined in this study.
The women in this study were more likely to receive care in hospitals with doctors experienced in treating IBC than the general population would be. This may have had an effect on the results.
What This Means for You
This study confirms that trimodality treatment is the most effective way to treat IBC. Despite this, many people are not treated with it. Researchers found that radiation therapy, in particular, is underused. Though radiation therapy may include multiple trips to your treatment center, travel costs and potential time away from work, it is important to complete this part of the three-part treatment.
If you have IBC and are considering treatments options, talk to your doctor about tridmodality treatment and ask if it’s right for you.
The researchers suggest the development of support programs for women who are most likely to experience barriers to the best care, such as those who are non-white, without private insurance and who have additional medical conditions.
Rueth, Natasha M.; Lin, Heather Y.; Bedrosian, Isabelle et al. Underuse of Trimodality Treatment Affects Survival for Patients With Inflammatory Breast Cancer: An Analysis of Treatment and Survival Trends From the National Cancer Database. Journal of Clinical Oncology. July 1, 2014; doi: 10.1200/JCO.2014.55.1978.