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

Gupta, Apar; Ohri, Nisha; Haffty, Bruce G.

doi:10.21037/tcr.2018.03.20

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…The control arm and the experimental arm fractionation schedules differed, which might be perceived as a confounding weakness – if one discards all current evidence of large prospective randomized trials showing that moderate hypofractionation does not affect the outcome of breast cancer [ 40 , 41 ]. Using normofractionation in the control arm maintained continuity with the majority of historic trials that demonstrated a survival advantage with breast radiotherapy [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…The control arm and the experimental arm fractionation schedules differed, which might be perceived as a confounding weaknessif one discards all current evidence of large prospective randomized trials showing that moderate hypofractionation does not affect the outcome of breast cancer [40,41]. Using In summary, improved cardiorespiratory-related outcome in tomotherapy patients is a proof of concept that advanced radiation techniques can have a substantial clinical impact.…”

Section: Discussionmentioning

confidence: 99%

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Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer

et al. 2021

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Background Long-term prospective patient-reported outcomes (PRO) after breast cancer adjuvant radiotherapy is scarce. TomoBreast compared conventional radiotherapy (CR) with tomotherapy (TT), on the hypothesis that TT might reduce lung-heart toxicity. Methods Among 123 women consenting to participate, 64 were randomized to CR, 59 to TT. CR delivered 50 Gy in 25 fractions/5 weeks to breast/chest wall and regional nodes if node-positive, with a sequential boost (16 Gy/8 fractions/1.6 weeks) after lumpectomy. TT delivered 42 Gy/15 fractions/3 weeks to breast/chest wall and regional nodes if node-positive, 51 Gy simultaneous-integrated-boost in patients with lumpectomy. PRO were assessed using the European Organization for Research and Treatment of Cancer questionnaire QLQ-C30. PRO scores were converted into a symptom-free scale, 100 indicating a fully symptom-free score, 0 indicating total loss of freedom from symptom. Changes of PRO over time were analyzed using the linear mixed-effect model. Survival analysis computed time to > 10% PRO-deterioration. A post-hoc cardiorespiratory outcome was defined as deterioration in any of dyspnea, fatigue, physical functioning, or pain. Results At 10.4 years median follow-up, patients returned on average 9 questionnaires/patient, providing a total of 1139 PRO records. Item completeness was 96.6%. Missingness did not differ between the randomization arms. The PRO at baseline were below the nominal 100% symptom-free score, notably the mean fatigue-free score was 64.8% vs. 69.6%, pain-free was 75.4% vs. 75.3%, and dyspnea-free was 84.8% vs. 88.5%, in the TT vs. CR arm, respectively, although the differences were not significant. By mixed-effect modeling on early ≤2 years assessment, all three scores deteriorated, significantly for fatigue, P ≤ 0.01, without effect of randomization arm. By modeling on late assessment beyond 2 years, TT versus CR was not significantly associated with changes of fatigue-free or pain-free scores but was associated with a significant 8.9% improvement of freedom from dyspnea, P = 0.035. By survival analysis of the time to PRO deterioration, TT improved 10-year survival free of cardiorespiratory deterioration from 66.9% with CR to 84.5% with TT, P = 0.029. Conclusion Modern radiation therapy can significantly improve long-term PRO. Trial registration Trial registration number ClinicalTrials.govNCT00459628, April 12, 2007 prospectively.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer

et al. 2021

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“…HF schemes also realize other goals of high-quality care, including patient centeredness, timeliness, efficiency, and equity. 37,38 Given that shorter courses of RT reduce the capital and operational investment needed to scale radiation oncology in LMICs, we anticipate an improvement in RT access with additional innovations that would allow for progressive HF until there are capabilities and techniques to deliver a single fraction without compromising the benchmarks of quality for RT delivery. We have depicted in Figure 2 these possible changes in treatment cost and percent reduction in cost from the CF prescription with each HF scheme.…”

Section: Discussionmentioning

confidence: 99%

Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy

Irabor

Swanson

Shaukat

et al. 2020

JCO Global Oncology

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PURPOSE The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries. METHODS The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory. RESULTS The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively. CONCLUSION This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.

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“…Hypofractionation also realise other goals of high-quality care, including patient centredness, timeliness, efficiency and equity. 60 This treatment regimen provides a convenience to patients, with fewer commutes to the radiation therapy centre, particularly for patients with logistical problems in reaching the radiation therapy facility. 59,61 Maximising access to radiation therapy for all referred patients dictates choosing the treatment regimen that is less toxic and most convenient to patients.…”

Section: Patient Centrednessmentioning

confidence: 99%

Unwarranted variation in radiation therapy fractionation

Batumalai

James

2022

J Med Imag Rad Onc

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The adoption of hypofractionation across multiple tumour sites has been slow despite robust evidence. There is considerable unwarranted variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician preference, lack of technology and differing financial incentives. Unwarranted variation in the use of hypofractionation has a tremendous effect on cost to both patients and the healthcare system. This places an unnecessary burden on patients and poorly utilises scarce healthcare resources. A collaborative effort from clinicians, patients, healthcare providers and policymakers is needed to reduce unwarranted variation in practice. This will improve quality of care both for patients and at broader healthcare system level.

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

Cited by 11 publications

References 24 publications

Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer

Cardiopulmonary-related patient-reported outcomes in a randomized clinical trial of radiation therapy for breast cancer

Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy

Unwarranted variation in radiation therapy fractionation

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