The Role of Facility Variation on Racial Disparities in Use of Hypofractionated Whole Breast Radiation Therapy

Laucis, Anna M.; Jagsi, Reshma; Griffith, Kent A.; Dominello, M.M.; Walker, Eleanor M.; Abu-Isa, Eyad; Dilworth, J.T.; Vicini, Frank A.; Kocheril, Paul G.; Browne, Cynthia Holland; Mietzel, Melissa A.; Moran, Jean M.; Hayman, James A.; Pierce, Lori J.

doi:10.1016/j.ijrobp.2020.04.035

Cited by 17 publications

(16 citation statements)

References 28 publications

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“…The uptake of HFRT is however significantly lower in the US – an increase from 3.8% in 2006 to 14% in 2010 in the SEER database, 9 and from 5% in 2004 to 23% in 2011 in the NCDB database 10 . More recent data from the Michigan Radiation Oncology Quality Consortium (MROQC) showed an increase in HFRT use from approximately 20% in 2012 to 57–73% for different racial groups in 2018 14 . In an earlier Australian study, the use of HFRT was reported to increase from 37% in 2008 to 49% in 2013 in public RT facilities in the state of New South Wales 12,16 …”

Section: Discussionmentioning

confidence: 99%

“…Racial disparities in HFRT use was recently evaluated using the MROQC database. On patient‐level analyses, Laucis et al reported that black patients were less likely to be treated with HFRT compared to white patients 14 . In Australia, the population that have been consistently reported to be disadvantaged in cancer care are the Aboriginal and Torres Straits Islander (ATSI) 22 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite this level 1 evidence, and the recommendation that HFRT should now be the standard of care, 7 there are huge variations reported in uptake of HFRT between different countries, geographical regions and institutions 8–14 . In 2016, the Royal Australian and New Zealand College of Radiologist (RANZCR) Faculty of Radiation Oncology has developed 5 radiation oncology specific Choosing Wisely (CW) recommendations to encourage adoption of evidence‐based practice in radiation oncology – one of which is to consider the use of HFRT for women aged 50 years and above with early stage BC 15 .…”

Section: Introductionmentioning

confidence: 99%

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Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

et al. 2021

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Introduction To evaluate the adoption of hypofractionated radiotherapy (HFRT) for breast cancer (BC) in Victoria, Australia. Methods This is a population‐based cohort of women with BC who had breast RT as captured in the Victorian Radiotherapy Minimum Data Set between 2012 and 2017. We defined HFRT as < 25 fractions of RT. The pattern of HFRT use over time was evaluated with the Cochrane–Armitage test for trend. Factors associated with HFRT were identified using multivariable logistic regression. Results 12,717 women were included in the study. Overall, 6,653 (52%) patients had HFRT. HFRT use increased from 35% in 2012 to 66% in 2017 (P‐trend < 0.001). Older women were more likely to have HFRT (74% for women aged ≥ 70 years vs. 27% for women aged < 50 years; P < 0.001). Women who had nodal irradiation were less likely to have HFRT compared with those who did not (13% vs. 57%; P < 0.001). HFRT use was more common in public than private institutions (57% vs. 46%, P < 0.001), and in metropolitan than regional centres (54% vs. 46%, P < 0.001). In multivariable analyses, the progressive increase in HFRT use over time was independent of other covariates – women treated in 2017 were 7.3 times (95% CI = 6.3–8.6, P < 0.001) more likely to be treated with HFRT than in 2012. Age at RT, nodal irradiation, area of residence and institutional type and locations were all independently associated with HFRT use. Conclusion This large Australian contemporary population‐based study demonstrates increasing use of HFRT for BC. However, large sociodemographic and institutional provider‐related variations in practice still exist.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

et al. 2021

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“…The patient characteristics analyzed included age (grouped as , 50 years, 50-59 years, 60-69 years, or $ 70 years), body mass index (BMI; grouped as , 18.5, 18.5 to , 25, 25 to , 30, 30 to , 35, 35 to , 40, and $ 40), race (defined by self-report where available and otherwise by clinician report, and grouped as White, Black, Asian, or other, with the "other" category including categories of American Indian/Alaska Native, Native Hawaiian or other Pacific Islander, Arab/Middle Eastern, or other), 14 hypertension (yes or no), diabetes (yes or no), smoking status (never, former, or current smoker), and chemotherapy receipt (yes or no). Physical measures of body habitus included from treatment planning scans were separation distance from medial and lateral tangential beam entry (continuously measured in centimeters) and breast volume (continuously measured in cubic centimeters).…”

Section: Methodsmentioning

confidence: 99%

Toward Improving Patients’ Experiences of Acute Toxicity From Breast Radiotherapy: Insights From the Analysis of Patient-Reported Outcomes in a Large Multicenter Cohort

Jagsi

Griffith

Vicini³

et al. 2020

JCO

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PURPOSE Understanding acute toxicities after whole-breast radiotherapy is important to inform patients, guide treatment decisions, and target supportive care. We evaluated patient-reported outcomes prospectively collected from a cohort of patients with breast cancer. METHODS We describe the maximal toxicity reported by 8,711 patients treated between 2012 and 2019 at 27 practices. Multivariable models identified characteristics associated with (1) breast pain, (2) bother from itching, stinging/burning, swelling, or hurting of the treated breast, and (3) fatigue within 7 days of completing whole-breast radiotherapy. RESULTS Moderate or severe breast pain was reported by 3,233 (37.1%): 1,282 (28.9%) of those receiving hypofractionation and 1,951 (45.7%) of those receiving conventional fractionation. Frequent bother from at least one breast symptom was reported by 4,424 (50.8%): 1,833 (41.3%) after hypofractionation and 2,591 (60.7%) after conventional fractionation. Severe fatigue was reported by 2,008 (23.1%): 843 (19.0%) after hypofractionation and 1,165 (27.3%) after conventional fractionation. Among patients receiving hypofractionated radiotherapy, younger age ( P < .001), higher body mass index (BMI; P < .001), Black ( P < .001) or other race ( P = .002), smoking status ( P < .001), larger breast volume ( P = .002), lack of chemotherapy receipt ( P = .004), receipt of boost treatment ( P < .001), and treatment at a nonteaching center predicted breast pain. Among patients receiving conventionally fractionated radiotherapy, younger age ( P < .001), higher BMI ( P = .003), Black ( P < .001) or other race ( P = .002), diabetes ( P = .001), smoking status ( P < .001), and larger breast volume ( P < .001) predicted breast pain. CONCLUSION In this large observational data set, substantial differences existed according to radiotherapy dose fractionation. Race-related differences in pain existed despite controlling for multiple other factors; additional research is needed to understand what drives these differences to target potentially modifiable factors. Intensifying supportive care may be appropriate for subgroups identified as being vulnerable to greater toxicity.

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“…There are already extensive racial and socioeconomic disparities in the use of evidence-based radiation treatment, such as for the treatment of breast and prostate cancers. 4,5 If APMs such as the RO model penalize and extract capital from clinics that serve vulnerable communities, such cancer disparities may worsen.…”

mentioning

confidence: 99%

Reforms to the Radiation Oncology Model: Prioritizing Health Equity

Erfani

Figueroa

Lam

2021

International Journal of Radiation Oncology*Biology*Physics

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Value-based health care has become a prime strategy in the US health care landscape to improve quality while controlling rising health care costs. Payors, including Medicare, have implemented alternative payment models (APMs) that tie quality and cost targets to reimbursement, but there is growing concern about how APMs affect vulnerable populations and the safety-net providers that care for them.The Centers for Medicare & Medicaid Services (CMS) recently released a radiation oncology (RO)-specific APM to disincentivize the use of highly compensated radiation modalities (prolonged fractionations, higher degree of complexity) over the use of equally effective, shorter, and simpler radiation treatments. The mandatory RO model randomizes practices into the APM by zip code and includes prospective 90-day episode-based payments for 16 cancer types. 1 Owing to implementation challenges and the uncertain effects of COVID-19, its launch was recently delayed to January 1, 2022. In the context of delays and a pandemic that has disproportionately taken the lives of poor people and racial minorities, we consider how the RO model can be improved to protect vulnerable populations from widening disparities.There are 3 main concerns about how the RO model may negatively affect vulnerable populations. First, analyses of similar APMs that incentivize value over volume suggest that they disproportionately penalize clinicians who take care of socially high-risk populations. For example, under

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The Role of Facility Variation on Racial Disparities in Use of Hypofractionated Whole Breast Radiation Therapy

Cited by 17 publications

References 28 publications

Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

Toward Improving Patients’ Experiences of Acute Toxicity From Breast Radiotherapy: Insights From the Analysis of Patient-Reported Outcomes in a Large Multicenter Cohort

Reforms to the Radiation Oncology Model: Prioritizing Health Equity

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