Oncology Rounds

The danger of missing radiation therapy appointments

by Deirdre Saulet

Patients miss scheduled radiation therapy appointments for many reasons—transportation issues, trouble finding child care, and fatigue, just to name a few. Not only can missed treatments impact providers’ revenue, but a new study also demonstrates an impact on patient outcomes. Patients who missed just two scheduled radiation therapy appointments had a sharp increase in rate of recurrence.

Looking at over 1,000 patients from 2007-2012

Researchers at Montefiore evaluated 1,227 patients scheduled for external beam radiation therapy from 2007 to 2012. The study included breast, lung, cervical, rectal, and head and neck cancer patients. Of those, 22% missed two or more scheduled radiation therapy appointments (noncompliant patients), although every patient eventually completed their full course of radiation.

Missing two appointments linked to increased rate of recurrence

The radiation therapy course for noncompliant patients was only prolonged for an average of one week compared to compliant patients. However, 16% of noncompliant patients experienced a recurrence of their disease compared to 7% of compliant patients.

Head and neck and cervical cancers saw the most significant impact on recurrence and overall survival, although the negative effect occurred in every tumor type studied.

Cancer programs need to implement targeted interventions

As Madhur Garg, MD, Clinical Director of the Department of Radiation Oncology at Montefiore Einstein Center for Cancer Care, expressed, “These findings should serve as a wakeup call to physicians, patients, and their caregivers about the critical need to adhere to a recommended treatment schedule.”

At Montefiore, physicians are now training non-clinical volunteers to identify patients at high risk for missing appointments and proactively reach out to them.

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