Hypofractionated Whole‐Breast Radiotherapy: Impact on Departmental Waiting Times and Cost

Abstract

Conventionally fractionated breast radiation therapy is delivered over 5-6 weeks. Randomised evidence has shown that hypofractionated whole-breast radiotherapy (HWBRT) over 3 weeks results in similar local control without increased toxicity. HWBRT is not standard practice in Australia for all eligible women. We examined the effect of using HWBRT (for eligible patients) on waiting lists and monetary costs. We identified factors associated with prescribing HWBRT. The Princess Alexandra Hospital Radiation Oncology Database was searched for all women with breast cancer treated with adjuvant radiotherapy in 2008. Included patients had undergone breast conserving surgery and had T1-2N0 tumours with negative margins. Women with large breasts and those receiving nodal irradiation were excluded. The outcome evaluated was fractionation schedule. Patient, tumour and treatment factors associated with the use of HWBRT were examined. The impact on departmental resources and health-care costs were calculated assuming the entire cohort received HWBRT. Two hundred seventy-nine patients met the inclusion criteria. Sixty-seven (24%) of these patients were treated with HWBRT. Compared with the conventionally fractionated breast radiation therapy group, the HWBRT group were older (median 69 vs. 54 years; P < 0.001) and more likely to have smaller tumours (12 mm vs. 15 mm; P = 0.02). Had all eligible patients received HWBRT an extra 14 patients each month could be treated and health-care costs would be reduced by 24%. HWBRT was more frequently prescribed in older women with small tumours. More widespread use of HWBRT would allow significantly more patients to be treated each month with considerable cost savings.

Utilization of Hypofractionated and Conventional Breast Radiotherapy in the State of Utah

“…Given the evidence that decreasing amount of fractions delivered decreases burden on the health care system (Dwyer et al, 2010) and the patient (Wallace et al, 1993), we believe there is sufficient evidence to suggest implementation of hypofractionation in appropriate patients will improve access to care and improve patient experience.…”

“…On an institutional level, though none of the facilities included in 2013 our analysis were from severely underserved regions, the prescription patterns for HF could reflect the providers' willingness to consider HF more often in institutions with a greater number of patients needing treatment. Previous analyses from Australia (Dwyer et al, 2010) examining the institutional cost of HF versus CF regimens, have shown that at least an extra fourteen patients could be treated each month with HF regimens and health related costs could be reduced by at least 24%.…”

The long-term outcome of adjuvant hypofractionated radiotherapy and conventional fractionated radiotherapy after breast-conserving surgery for early breast cancer: a prospective analysis of 107 cases

“…However, HF is advantageous because it has shorter treatment time and fewer radiotherapy fractions, thereby reducing patient expenditures (28) and conserving medical resources. Thus, HF is more convenient for patients who want to seek for medical attention and improve their radiotherapy compliance.…”

Are Cancer Patients Willing to Travel More or Further Away for a Slightly More Efficient Therapy?

“…Use of the less travelling intensive hypofractionated breast radiotherapy versus conventional breast radiotherapy was recently published as strongly correlated with the distance to the clinic (Page et al, 2013). Some reports reveal that an average of 20-30% of North American women forego radiotherapy after receiving lumpectomy (Chuba & Simon, 1997;Malin, Schuster, Kahn, & Brook, 2002), or choose mastectomy over breast preservation (Tuttle, Habermann, Grund, Morris, & Virnig, 2007) due to several factors, including age, psychological distress, quality of life concerns, and cost of undergoing prolonged daily radiotherapy (Dwyer, Hickey, Burmeister, & Burmeister, 2010).…”