Key result
Conventional fractionated radiation was used in 75% of older women with early-stage breast cancer, and IMRT in 20%, both of which were associated with increased cost relative to hypofractionation.
Why the study?
Guideline adherence and financial implications of ASTRO Choosing Wisely recommendations regarding hypofractionated radiation and avoiding routine IMRT in early-stage breast cancer had not been evaluated in a modern Medicare cohort.
What are the utilization rates and financial implications of hypofractionated radiation and IMRT in older women with early-stage breast cancer?
Cohort
Yes
What are the utilization rates and financial implications of hypofractionated radiation and IMRT in older women with early-stage breast cancer?
Absolute Event Rate: 25% vs 75%
Despite Choosing Wisely guidelines recommending hypofractionated radiation, the majority of older women with early-stage breast cancer receive conventional fractionation or IMRT, resulting in increased healthcare costs.
May not yet alter radiation practice or policy; leaves open barriers to hypofractionation adoption.
BACKGROUND: American Society of Radiation Oncology Choosing Wisely campaign recommends hypofractionated radiation and against routine use of intensity-modulated radiation therapy (IMRT) in early-stage estrogen receptor-positive breast cancer. We analyzed guideline recommendation adherence and financial implications in a modern Medicare cohort of women treated across the southeastern United States. METHODS: Our study population comprised Medicare patients over 65 years of age with breast cancer diagnosis from 12 cancer centers in the Southeast United States with stage 0-II breast treated with lumpectomy from 2012 to 2015. Hypofractionation was defined as 4 or fewer weeks of radiation treatments. Factors associated with utilization of hypofractionation and IMRT were identified using Poisson regression. Median costs during radiation treatments were compared for hypofractionation and IMRT. RESULTS: In older women (median age 71), 75% were treated with conventional fractionation, and 20% received IMRT. Hypofractionated women were more likely to have a positive estrogen(ER) or progestorone(PR) receptor status, lower comorbidity scores, and be treated at a high volume center (all P < 0.05). IMRT was utilized in 20% of patients and was more common in women treated with conventional fractionation (P < 0.001). Positive ER/PR status (P < 0.001) and utilization of hormonal blockade (P = 0.02) were associated with increased utilization of IMRT. CONCLUSION: In an older cohort of patients with early-stage breast cancer, a majority were treated with conventional fractionated radiation, while approximately 20% were treated with IMRT. Both of which were associated with increased cost relative to hypofractionation.
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Wallace et al. (2019) conducted a cohort in Early-stage breast cancer. Hypofractionated radiation vs. Conventional fractionated radiation was evaluated on Utilization of radiation fractionation schedules. Conventional fractionated radiation was used in 75% of older women with early-stage breast cancer, and IMRT in 20%, both of which were associated with increased cost relative to hypofractionation.