title: Factors Influencing Compliance to Radical Treatment of Middle Thoracic Esophageal Cancer: An Audit from a Regional Cancer Centre.
abstract: BACKGROUND
  The aim of this study is to identify the factors responsible for interruption of planned treatment in patients of carcinoma mid-thoracic esophagus and also discuss the strategies for improving treatment completion rates.
  
  
  METHODS
  Patients with nonmetastatic mid-thoracic esophageal cancer who received treatment by multimodality approach using chemotherapy, radiation, and/or surgery were retrospectively analyzed. Factors influencing compliance with planned treatment completion were evaluated, and their significance was determined using multivariate Cox regression analysis.
  
  
  RESULTS
  Ninety-one patients were reviewed. Median follow-up period was 11 months. Of 15 patients planned with neoadjuvant chemoradiation followed by surgery (Group 1), only 6 (40%) could complete the treatment. Similarly, only 19 out of 36 patients (52.8%) completed the planned definitive chemoradiation (Group 2). Furthermore, of forty patients planned with definitive radiotherapy (Group 3), 29 patients only (72.5%) completed this schedule. The rate of completion of therapy was worst in Group 1. The most common reason for noncompletion of planned treatment was nutritional inadequacy and excessive weight loss in all groups. In addition, chemotherapy-induced myelosuppression (P = 0.05) was the factor leading to treatment interruption in Group 2 and radiation-induced acute mucositis (P = 0.02) and lost to follow-up (P = 0.02) were the factors in Group 3.
  
  
  CONCLUSIONS
  Rate of treatment completion significantly impacts survival rates. Nutritional inadequacy was the most common factor for noncompletion of planned treatment. A well-trained management team consisting of oncologist, dietitian, and psychotherapist can help overcome these factors and thereby improve the treatment completion rates.
authors: Department of Radiotherapy, PGIMER, Chandigarh, India.
authors: Rakesh
authors: R
authors: Kapoor
authors: Department of Radiotherapy, PGIMER, Chandigarh, India.
authors: Anshuma
authors: A
authors: Bansal
authors: Department of Radiotherapy, PGIMER, Chandigarh, India.
authors: Shikhar
authors: S
authors: Kumar
authors: Department of Radiotherapy, PGIMER, Chandigarh, India.
authors: Ravi Teja
authors: RT
authors: Miriyala
keywords: Compliance; Esophageal cancer; Multimodality treatment; Treatment completion