Choosing wisely after publication of level I evidence in breast cancer radiotherapy

Joshua R Niska,1 Sameer R Keole,1 Barbara A Pockaj,2 Michele Y Halyard,1 Samir H Patel,1 Donald W Northfelt,3 Richard J Gray,2 Nabil Wasif,2 Carlos E Vargas,1 William W Wong1 1Department of Radiation Oncology, 2Division of General Surgery, 3Division of Hematology and Medical Oncology, Mayo Clinic Ho...

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Autores principales:	Niska JR, Keole SR, Pockaj BA, Halyard MY, Patel SH, Northfelt DW, Gray RJ, Wasif N, Vargas CE, Wong WW
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	breast cancer CALGB choosing wisely hypofractionation omission UK START Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/b8a5fceb25494c9bab4ab1e561c46055
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spelling	oai:doaj.org-article:b8a5fceb25494c9bab4ab1e561c460552021-12-02T05:34:48ZChoosing wisely after publication of level I evidence in breast cancer radiotherapy1179-1314https://doaj.org/article/b8a5fceb25494c9bab4ab1e561c460552018-02-01T00:00:00Zhttps://www.dovepress.com/choosing-wisely-after-publication-of-level-i-evidence-in-breast-cancer-peer-reviewed-article-BCTThttps://doaj.org/toc/1179-1314Joshua R Niska,1 Sameer R Keole,1 Barbara A Pockaj,2 Michele Y Halyard,1 Samir H Patel,1 Donald W Northfelt,3 Richard J Gray,2 Nabil Wasif,2 Carlos E Vargas,1 William W Wong1 1Department of Radiation Oncology, 2Division of General Surgery, 3Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA Background: Recent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT) as part of breast-conserving therapy (BCT). Evidence also suggests that radiotherapy (RT) omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT) is more expensive than 3-dimensional conformal RT (3DCRT). Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO) recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT. To assess response to level I evidence and adherence to ASTRO recommendations, we evaluated the pattern of RT use for early-stage breast cancer at our National Comprehensive Cancer Network institution from 2006 to 2008 and 2011 to 2013 and compared the results with national trends. Methods: Data from a prospective database were extracted to include patients treated with BCT, aged ≥50 years, with histologic findings of invasive ductal carcinoma, stage T1-T2N0M0, estrogen receptor-positive, and HER2 normal. We retrospectively reviewed the medical records and estimated costs based on 2016 Hospital Outpatient Prospective Payment System (technical fees) and Medicare Physician Fee Schedule (professional fees). Results: Among 55 cases from 2006 to 2008, treatment regimens were 11% hypofractionated, 69% traditional schedule, and 20% RT omission (29% of patients were aged >70 years). Among 83 cases from 2011 to 2013, treatment regimens were 54% hypofractionated, 19% traditional schedule, and 27% RT omission (48% of patients were aged >70 years). 3DCRT was used for all WBRT treatments. Direct medical cost estimates were as follows: 15 fractions 3DCRT, $7,197.87; 15 fractions IMRT, $11,232.33; 25 fractions 3DCRT, $9,731.39; and 25 fractions IMRT, $16,877.45. Conclusion: Despite apparent resistance to shorter radiation schedules in the United States, we demonstrate that rapid practice change in response to level I evidence is feasible. Wider adoption of evidence-based guidelines in early-stage breast cancer may substantially lower health care costs and improve convenience for patients without sacrificing oncologic outcomes. Keywords: breast cancer, CALGB, choosing wisely, hypofractionation, omission, UK STARTNiska JRKeole SRPockaj BAHalyard MYPatel SHNorthfelt DWGray RJWasif NVargas CEWong WWDove Medical Pressarticlebreast cancerCALGBchoosing wiselyhypofractionationomissionUK STARTNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBreast Cancer: Targets and Therapy, Vol Volume 10, Pp 31-37 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	breast cancer CALGB choosing wisely hypofractionation omission UK START Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	breast cancer CALGB choosing wisely hypofractionation omission UK START Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Niska JR Keole SR Pockaj BA Halyard MY Patel SH Northfelt DW Gray RJ Wasif N Vargas CE Wong WW Choosing wisely after publication of level I evidence in breast cancer radiotherapy
description	Joshua R Niska,1 Sameer R Keole,1 Barbara A Pockaj,2 Michele Y Halyard,1 Samir H Patel,1 Donald W Northfelt,3 Richard J Gray,2 Nabil Wasif,2 Carlos E Vargas,1 William W Wong1 1Department of Radiation Oncology, 2Division of General Surgery, 3Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ, USA Background: Recent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT) as part of breast-conserving therapy (BCT). Evidence also suggests that radiotherapy (RT) omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT) is more expensive than 3-dimensional conformal RT (3DCRT). Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO) recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT. To assess response to level I evidence and adherence to ASTRO recommendations, we evaluated the pattern of RT use for early-stage breast cancer at our National Comprehensive Cancer Network institution from 2006 to 2008 and 2011 to 2013 and compared the results with national trends. Methods: Data from a prospective database were extracted to include patients treated with BCT, aged ≥50 years, with histologic findings of invasive ductal carcinoma, stage T1-T2N0M0, estrogen receptor-positive, and HER2 normal. We retrospectively reviewed the medical records and estimated costs based on 2016 Hospital Outpatient Prospective Payment System (technical fees) and Medicare Physician Fee Schedule (professional fees). Results: Among 55 cases from 2006 to 2008, treatment regimens were 11% hypofractionated, 69% traditional schedule, and 20% RT omission (29% of patients were aged >70 years). Among 83 cases from 2011 to 2013, treatment regimens were 54% hypofractionated, 19% traditional schedule, and 27% RT omission (48% of patients were aged >70 years). 3DCRT was used for all WBRT treatments. Direct medical cost estimates were as follows: 15 fractions 3DCRT, $7,197.87; 15 fractions IMRT, $11,232.33; 25 fractions 3DCRT, $9,731.39; and 25 fractions IMRT, $16,877.45. Conclusion: Despite apparent resistance to shorter radiation schedules in the United States, we demonstrate that rapid practice change in response to level I evidence is feasible. Wider adoption of evidence-based guidelines in early-stage breast cancer may substantially lower health care costs and improve convenience for patients without sacrificing oncologic outcomes. Keywords: breast cancer, CALGB, choosing wisely, hypofractionation, omission, UK START
format	article
author	Niska JR Keole SR Pockaj BA Halyard MY Patel SH Northfelt DW Gray RJ Wasif N Vargas CE Wong WW
author_facet	Niska JR Keole SR Pockaj BA Halyard MY Patel SH Northfelt DW Gray RJ Wasif N Vargas CE Wong WW
author_sort	Niska JR
title	Choosing wisely after publication of level I evidence in breast cancer radiotherapy
title_short	Choosing wisely after publication of level I evidence in breast cancer radiotherapy
title_full	Choosing wisely after publication of level I evidence in breast cancer radiotherapy
title_fullStr	Choosing wisely after publication of level I evidence in breast cancer radiotherapy
title_full_unstemmed	Choosing wisely after publication of level I evidence in breast cancer radiotherapy
title_sort	choosing wisely after publication of level i evidence in breast cancer radiotherapy
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/b8a5fceb25494c9bab4ab1e561c46055
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Choosing wisely after publication of level I evidence in breast cancer radiotherapy

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