Patterns of care study in Japan: analysis of patients subjected to mastectomy followed by radiotherapy.
BACKGROUND
Two prospective studies reported in 1997 demonstrated that postoperative radiotherapy after mastectomy was not only associated with a higher loco-regional control rate but also with a higher overall survival rate. The purpose of this study is to clarify the processes of care for patients undergoing mastectomy and postoperative radiotherapy in Japan.


METHODS
A national survey carried out in 1998-2000, involving 79 Japanese institutions by two-stage cluster sampling of institutions and patients, disclosed that 1124 patients with breast cancer had been treated between 1995 and 1997. Mastectomy followed by radiotherapy was performed on 258 patients.


RESULTS
The compliance rates for pre-treatment evaluation, including history, physical examination and mammography, averaged approximately 50% (24-81%). The chest wall was irradiated in only 19% of the patients and regional node irradiation was carried out for 70-86%. Radiation treatment planning with the aid of computed tomography was done in only 29% of patients (university hospitals or cancer centers, 39%; other hospitals, 17%; P = 0.001). Hormonal therapy was administered to 56% of the patients who showed no endocrine responsiveness. Non-intensive chemotherapy, which did not include the use of anthracycline or taxol, was used in 55% of the patients who received chemotherapy.


CONCLUSIONS
There is room for improvement regarding some aspects of radiotherapy and adjuvant systemic therapies. Especially in the field of radiotherapy, significant differences were found among the treatment techniques employed in various institutions.
Shikama
Naoto
N
Japanese PCS Working Subgroup of Breast Cancer, Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan. shikama@hsp.md.shinshu-u.ac.jp
Sasaki
Shigeru
S
Mitsumori
Michihide
M
Hiraoka
Masahiro
M
Yamauchi
Chikako
C
Yamamoto
Tokihiro
T
Teshima
Teruki
T
Inoue
Toshihiko
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007564:Japan; D008327:Mammography / Q000706:statistics & numerical data; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D011182:Postoperative Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011879:Radiotherapy Dosage
D018931:Antineoplastic Agents, Hormonal