(S042) Changing Practice Patterns for Breast Cancer Radiotherapy With Clinical Pathways: An Analysis of Hypofractionation in a Large Integrated Cancer Center Network

Publication
Article
OncologyOncology Vol 28 No 4_Suppl_1
Volume 28
Issue 4_Suppl_1

Hypofractionated whole-breast irradiation (HF-WBI) following breast-conserving surgery has produced excellent outcomes, but utilization remains limited. We evaluated the impact of a clinical pathway on adoption of HF-WBI in a large integrated radiation oncology network.

Malolan S. Rajagopalan, MD, John C. Flickinger, MD, Sushil Beriwal, MD, Dwight E. Heron, MD, FACRO, FACR; University of Pittsburgh Cancer Institute

Purpose: Hypofractionated whole-breast irradiation (HF-WBI) following breast-conserving surgery has produced excellent outcomes, but utilization remains limited. We evaluated the impact of a clinical pathway on adoption of HF-WBI in a large integrated radiation oncology network.

Methods: We identified patients aged ≥ 70 years treated for breast cancer or ductal carcinoma in situ (DCIS). Excluded patients were those treated with palliative intent; accelerated partial breast radiation following mastectomy; or with axillary, supraclavicular, or internal mammary fields HF-WBI was defined as ≤ 20 fractions with a dose/fraction ≥ 2.5 Gy. Multivariate analysis identified variables associated with increased HF-WBI utilization.

Results: We identified 2,426 patients meeting the inclusion criteria. HF-WBI utilization increased from 6.5% before pathway modification to 33.8% afterwards (P < .001). For academic physicians, the odds of utilizing HF-WBI increased 4.1 times following publication of the seminal HF-WBI trial and an additional 3.2 times following pathway modification (P < .001 and P = .001, respectively). For community physicians, the odds of HF-WBI did not change following publication but increased 20 times following pathway modification (P < .001). The increased adoption of HF-WBI saves $377,000 annually in our network and $51 million annually if extrapolated nationally.

Conclusions: We found that our implementation of clinical pathways dramatically increased adoption of HF-WBI for breast cancer in a large integrated cancer network. We found no significant change in utilization of HF-WBI among community physicians following publication of a seminal trial for HF-WBI until after clinical pathway implementation, which led to a 20-fold increase. Clinical pathways can be highly effective in changing practice patterns, disseminating evidence, and realizing health care savings.

Proceedings of the 96th Annual Meeting of the American Radium Society - americanradiumsociety.org

Articles in this issue

(S002) Outcomes and Prognostic Factors of Stereotactic Body Radiotherapy for Soft Tissue Sarcoma Metastases
(S001) Limb-Sparing Surgery and Intraoperative Radiotherapy in the Treatment of Primary, Nonmetastatic Extremity and Limb-Girdle Soft Tissue Sarcoma
(S003) Disparities in Stage at Diagnosis and Survival in Adult Cancer Patients According to Insurance Status
(S004) Radiation Publications Underrepresented in High-Impact General Medical and Oncology Journals 
(S005) Adjuvant Radiotherapy in Stage II Endometrial Carcinoma: Is Brachytherapy Alone Sufficient for Local Control?
(S006) Extended-Field IMRT With Concomitant Boost for Node-Positive Cervical Cancer: Analysis of Regional Control Rate and Recurrence Pattern
(S007) Stereotactic Radiosurgery to the Brain With Concurrent BRAF Inhibitors for Melanoma Metastases
(S008) Use of Mobile Devices for Creation of Survivorship Care Plans
(S009) Two-Year Outcomes Following Triapine Radiochemotherapy for Cervical Cancer 
(S010) Prospective and Real-Time Data Analysis of Image-Guided Radiotherapy Across a Multinational Pediatrics Consortium: Methodology and Considerations 
(S011) Comparison of Toxicities and Outcomes for Conventional and Hypofractionated Radiation Therapy for Early Glottic Carcinoma
(S013) Adjuvant Radiation Therapy and Temozolomide for Anaplastic Gliomas: The Twelve-Year Washington University Experience
(S014) Gamma Knife Stereotactic Radiosurgery in the Treatment of Brainstem Metastases
(S015) Temporal Lobe Radionecrosis After Skull Base Radiotherapy: Dose-Volume Predictors 
(S012) Prognostic Value of Radiographic Extracapsular Extension in Locally Advanced Non-Oropharyngeal Head and Neck Squamous Cell Cancers
Related Videos
Barbara Smith, MD, PhD, spoke about the potential use of pegulicianine-guided breast cancer surgery based on reports from the phase 3 INSITE trial.
Patient-reported symptoms following surgery appear to improve with the use of perioperative telemonitoring, says Kelly M. Mahuron, MD.
Treatment options in the refractory setting must improve for patients with resected colorectal cancer peritoneal metastasis, says Muhammad Talha Waheed, MD.
Although immature, overall survival data from the KEYNOTE-868 trial may support the use of pembrolizumab plus chemotherapy in patients with endometrial cancer.
Dostarlimab plus chemotherapy appears to yield favorable overall survival in patients with mismatch repair proficient endometrial cancer.
Some patients with large B-cell lymphoma may have to travel a great distance for an initial evaluation for CAR T-cell therapy.
Brian Slomovitz, MD, MS, FACOG discusses the use of new antibody drug conjugates for treating patients with various gynecologic cancers.
Education is essential to referring oncologists manage toxicities associated with CAR T-cell therapy for patients with large B-cell lymphoma.
There is no absolute age cutoff where CAR T cells are contraindicated for those with large B-cell lymphoma, says David L. Porter, MD.
David L. Porter, MD, emphasizes referring patients with large B-cell lymphoma early for CAR T-cell therapy consultation.
Related Content