A study titled, “Rate of Whole Breast Hypofractionated Radiation Therapy Pre- Versus Post-Virtual Tumor Board Implementation” has been presented at the National Consortium of Breast Centers 2020 Interdisciplinary Breast Center Conference, which was held from April 3rd through 8th in Las Vegas, Nevada. The study was conducted jointly by HealthHelp and Humana as a part of the ongoing research alliance between the two organizations.
A Virtual Tumor Board (VTB) is a multidisciplinary group of specialist physicians who remotely work to educate the treating physician on the development of a cancer treatment plan that will enhance patient outcomes, based upon the available peer-reviewed literature. According to the National Comprehensive Cancer Network guidelines, the use of hypofractionated (HF) radiation therapy (RT) is a preferred approach for the treatment of breast cancer after breast-conserving surgery. Thus, HF is encouraged by the VTB when appropriate.
The purpose of this study was to show how the relative use of HF and conventional fractionated (CF) RT changed after the implementation of the VTB.The study had an observational, historical cohort design and was conducted using prior authorization and administrative claims data. Orders and claims for qualifying patients from one year pre-launch of the VTB (8/2016) to one year post-launch of the VTB (8/2018) were extracted. Patients were excluded if they resided where the VTB was piloted, were not continuously enrolled in their health plan for 70 days following their RT order, had a mastectomy, positive lymph nodes, were aged 90 or older, or had a number of fractions not consistent with HF (15-21) or CF (28-35). RT claims for patients occurring more than 70 days after their orders were excluded from the study. Claims in the 70 days following the order were examined to determine which patients received HF versus CF. Chi-square tests were used to assess the association between time period and the ordering and use of HF. Logistic regressions were used to test the association, after adjusting for the patient’s age, urbanicity, residence in a ZIP code with average income <$40,000, and the RT modality used.
Post-implementation, we observed a significantly higher percentage of orders for HF (60.3% [1,254/2,079] vs. 53.2% [1,010/1,899], P<.001) and a significantly higher percentage of claims for HF (71.5% [1,143/1,598] vs. 59.0% [941/1,595], P<.001). Relative to pre-implementation, the adjusted odds of an order for HF was 1.35 (confidence interval [CI]: 1.19-1.54), and the adjusted odds of a claim for HF was 1.76 (CI: 1.52-2.04). HF orders were significantly and negatively associated with younger age, residing in a lower income ZIP code, having Medicare Advantage, and the use of intensity-modulated RT. The same associations were significant in the claims analysis.
The study concluded that after the VTB was implemented, there was a significant increase in both orders for HF and claims for HF. In reaction to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., commented, “Last year, our research team found that breast cancer patients receiving orders for hypofractionated radiation therapy were significantly more likely to complete their treatment than patients receiving orders for conventional radiation therapy, suggesting that orders for hypofractionated radiation therapy lead to better quality care. This study shows that the use of a virtual tumor board may be a means for increasing the percentage of patients receiving hypofractionated regimens. Our prior study shows why encouraging hypofractionation is important, and this study shows how it can be encouraged.”
To learn more about the conference, please click here: https://www2.breastcare.org/welcome-to-the-annual-national-interdisciplinary-breast-center-conference/