The use of short-course whole-breast irradiation (WBI) after breast-conserving surgery increased among women with early-stage breast cancer between 2008 and 2013, according to a study published online in the Journal of the American Medical Association. But its use still remains lower in the U.S. than in other countries.
"Hypofractionated WBI increases convenience, reduces treatment burden, and lowers healthcare costs while offering similar cancer control to conventional WBI," wrote lead author Dr. Justin Bekelman, from the University of Pennsylvania, and colleagues. "Furthermore, patients prefer shorter radiation treatment regimens."
Conventional WBI consists of five to seven weeks of daily radiation treatments. Hypofractionated, or short-course, WBI delivers fewer but higher-dose treatments over three weeks. However, Bekelman's group found that only 34.5% of patients eligible for the protocol received it (JAMA, December 10, 2014).
Why? In 2011, American Society for Radiation Oncology (ASTRO) practice guidelines concluded that hypofractionated and conventional WBI were equally effective for in-breast tumor control and comparable in terms of long-term side effects for selected women. But the guidelines stopped short of recommending hypofractionated WBI as a care standard to be used in place of conventional WBI, according to Bekelman and colleagues.
"The absence of a clear recommendation may have contributed to slower uptake of hypofractionation in the U.S. than in other countries," they wrote.
The team used data from the HealthCore Integrated Research Database, which links medical and pharmacy administrative claims and eligibility files from 14 commercial healthcare plans across the U.S., comprising 58 million covered lives.
The final cohort included 15,643 women; 8,924 were categorized into a "hypofractionated-endorsed" group (patients 50 years of age or older without prior chemotherapy or axillary lymph node involvement) and 6,719 into a "hypofractionated-permitted" group (patients younger than 50 who had prior chemotherapy or axillary lymph node involvement).
In the first group, the proportion of patients who underwent short-course WBI went from 10.6% in 2008 to 34.5% in 2013. In the second group, the proportion of patients who underwent short-course WBI increased from 8.1% in 2008 to 21.2% in 2013. In addition, mean total health expenditures for patients undergoing this protocol were about 10% less than for patients who had conventional WBI.
"Our findings highlight differences in international care patterns for early-stage breast cancer," the researchers concluded.
