The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Boero, Isabel J.; Gillespie, Erin F.; Hou, Jiayi; Paravati, Anthony J.; Kim, Ellen; Einck, John; Yashar, Catheryn M.; Mell, Loren K.; Murphy, James D.

doi:10.1016/j.ijrobp.2016.11.009

Cited by 23 publications

(31 citation statements)

References 50 publications

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“…Although not as strongly suggested as in other studies, the impact of individual clinician's practice pattern remained a significant predictor of the HF‐WBRT adoption in our study. In several US centres, implementation of clinical directives and peer‐reviewed chart‐rounds (as a mean of negating individual clinician's perception towards HF‐WBRT) have resulted in a significant increase in the HF‐WBRT adoption .…”

Section: Discussioncontrasting

confidence: 81%

“…While the HF‐WBRT adoption rate clearly increased over time and was largely reflective of the sequential publications of high‐level clinical evidence, mainstreaming of HF‐WBRT into clinical practice as the preferred fractionation regimen for early‐stage breast cancer patients required a prolonged period of adjustment for the clinicians. As postulated in the earlier studies, this lag may reflect the clinicians’ reservation in treatment de‐escalation and caution in extrapolating the data beyond the guideline‐endorsed criteria. Our results found that the delivery of chemotherapy and/or TBBR, and larger CWSD negatively predicted for HF‐WBRT prescription, even after the random clinician effect was adjusted for.…”

Section: Discussionmentioning

confidence: 92%

“…In line with the accumulating evidence, several international and national clinical guidelines have been formulated, endorsing the use of HF‐WBRT in a selected group of patients . Despite these efforts, the uptake of HF‐WBRT in clinical practice has been slower than expected, for which potential drivers have been identified at patient, disease and care provider levels . The incremental adoption of HF‐WBRT has continued in the recent years despite increased accessibility to advanced radiotherapy techniques capable of mitigating earlier concerns regarding dose inhomogeneity and the related suboptimal late normal tissue outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Temporal impact of the publication of guidelines and randomised evidence on the adoption of hypofractionated whole breast radiotherapy for early‐stage breast cancer

2019

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Introduction: Clinical data supporting the use of hypofractionated whole breast radiotherapy (HF-WBRT) in early-stage breast cancer patients have accumulated over the last decade. Despite the availability of the published evidence, the adoption rate of HF-WBRT has been slower-than-expected. We sought to assess the temporal impact of the publication of the guidelines and randomised evidence on the practice pattern of HF-WBRT and identify clinical predictors of its utilisation. Methods: Women with early-stage breast cancer who received adjuvant WBRT at Canberra Health Services between 2008 and 2016 were identified from clinical databases. The patterns of HF-WBRT use were analysed in relation to pre-specified time periods (before and after the guideline publications) in the entire cohort as well as in a patient subset fulfilling the criteria for HF-WBRT according to the guidelines (referred to as 'guideline-endorsed subset'). The impact of clinical variables, treating clinicians and the time periods on the adoption of HF-WBRT was assessed by hierarchical multivariate logistic regressions. Results: Of the entire cohort (n = 1171), the guideline-endorsed subset constituted 51.6% (n = 604) of the patients. HF-WBRT was utilised in 32.8% of the entire cohort and 46.2% of the guideline-endorsed subset. Between 2008 and 2016, HF-WBRT use rate increased from 12.1% to 56.6% in a non-linear pattern. Release of international and local consensus guidelines significantly correlated with the increase in HF-WBRT utilisation rate. The use of chemotherapy and/or tumour bed boost radiotherapy (TBBR), chest wall separation distance (CWSD) and patient age were significant predictors of HF-WBRT use on multivariate analyses. After factoring in the effects of individual clinicians and the time periods on hierarchical multivariate analyses, the use of chemotherapy, TBBR, and CWSD remained as significant variables. Clinicians contributed to the variability in the HF-WBRT adoption pattern. Conclusion: The temporal uptake pattern and the predictors of adjuvant HF-WBRT use in early breast cancer patients largely reflected the accumulating clinical evidence and the publication of the consensus guidelines. This study identified potentially modifiable factors associated with slower-than-expected uptake rate of HF-WBRT. Understanding why there is variability in clinicians' readiness to adopt the abbreviated treatment despite the availability of advanced radiotherapy techniques and the updated evidence is an important step towards formulating effective strategies to optimise the radiotherapeutic management of this common malignancy.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Temporal impact of the publication of guidelines and randomised evidence on the adoption of hypofractionated whole breast radiotherapy for early‐stage breast cancer

2019

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“…If approved, CMS enters into a Data Use Agreement (DUA) with the researcher. These data have been used to describe patterns of morbidity2 and mortality3 and burden of disease,4,5 compare the effectiveness of pharmacologic therapies,6–9 examine the cost of care,10–13 evaluate the effects of provider practices on the delivery of care,14–17 and explore the effects of important policy changes on physician practices and patient outcomes 18–23. The use of the Medicare databases as sources for epidemiologic and health outcomes research has increased substantially over time (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the US

Mues¹,

Liede²,

Liu³

et al. 2017

CLEP

170

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Medicare is the federal health insurance program for individuals in the US who are aged ≥65 years, select individuals with disabilities aged <65 years, and individuals with end-stage renal disease. The Centers for Medicare and Medicaid Services grants researchers access to Medicare administrative claims databases for epidemiologic and health outcomes research. The data cover beneficiaries’ encounters with the health care system and receipt of therapeutic interventions, including medications, procedures, and services. Medicare data have been used to describe patterns of morbidity and mortality, describe burden of disease, compare effectiveness of pharmacologic therapies, examine cost of care, evaluate the effects of provider practices on the delivery of care and patient outcomes, and explore the health impacts of important Medicare policy changes. Considering that the vast majority of US citizens ≥65 years of age have Medicare insurance, analyses of Medicare data are now essential for understanding the provision of health care among older individuals in the US and are critical for providing real-world evidence to guide decision makers. This review is designed to provide researchers with a summary of Medicare data, including the types of data that are captured, and how they may be used in epidemiologic and health outcomes research. We highlight strengths, limitations, and key considerations when designing a study using Medicare data. Additionally, we illustrate the potential impact that Centers for Medicare and Medicaid Services policy changes may have on data collection, coding, and ultimately on findings derived from the data.

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“…The UK and Canada have seen far broader adoption of HF-WBI (around 80% and 71%, respectively) (18,19), which can in part be attributed to the UK’s nationalized adoption of HF-WBI and Canada’s more flexible use of fee-for-service payments. It is estimated that a US hospital-based practice’s adoption of a 70% HF-WBI rate would result in annual reductions of $300,790 in technical revenues and 731 professional RVUs with current reimbursement policies (20), representing significant proportions of total practice income; therefore, it is not surprising that variation in HF-WBI utilization has been found to be related more to individual provider characteristics than clinical or demographic characteristics (21). …”

mentioning

confidence: 99%

Hypofractionated whole breast irradiation is cost-effective—but is that enough to change practice?

2018

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The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer

Cited by 23 publications

References 50 publications

Temporal impact of the publication of guidelines and randomised evidence on the adoption of hypofractionated whole breast radiotherapy for early‐stage breast cancer

Temporal impact of the publication of guidelines and randomised evidence on the adoption of hypofractionated whole breast radiotherapy for early‐stage breast cancer

Use of the Medicare database in epidemiologic and health services research: a valuable source of real-world evidence on the older and disabled populations in the US

Hypofractionated whole breast irradiation is cost-effective—but is that enough to change practice?

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