A research paper titled, “The Association between Use of Hypofractionation and Treatment Completion among Recipients of Radiation Therapy Post-Mastectomy” has been published online by Practical Radiation Oncology. The findings of the study had previously been presented at the 2019 American Society for Radiation Oncology (ASTRO) Annual Meeting.
The study explored the relationship between the decision to use hypofractionated (HF) radiation therapy versus conventionally fractionated (CF) radiation therapy for the treatment of breast cancer and completion of the full course of treatment. When patients receive radiation therapy, it occurs over a series of sessions which are referred to as fractions. HF radiation therapy involves delivering a shorter course of treatment (fewer fractions) than would occur with CF.
Orders for radiation therapy placed in 2016 and 2017 were included in the analysis if they pertained to patients from one national healthcare organization that were being treated for breast cancer post-mastectomy, and did not indicate conditions that would contraindicate HF. Orders were also excluded if they did not fall into the range indicated for HF (15 to 20 fractions) or CF (25 or more fractions). Target on-time treatment completion dates were calculated for each order. Orders were classified as being either for HF or CF. The outcomes examined were whether claims data indicated that RT was completed by the target date, whether RT was completed within 30 days of the target date, and the length of delay in completion among patients that completed treatment with a delay no longer than 30 days. Univariate analyses and logistic regressions were conducted to test for an association between regimen and completion. A Poisson regression was used to examine the association between regimen and length of treatment delay among patients completing RT.
Of the 743 orders meeting inclusion criteria, 56 (7.5%) were for HF. Unadjusted analyses found that the timely and delayed completion rates were significantly (P<.001) higher for patients receiving HF. The adjusted odds of timely completion for patients receiving HF were 3.96 (95% CI: 2.23-7.01), and were 2.64 (95% CI: 1.43-5.15) for completion within 30 days of the target. Among completers, HF was significantly (P<.001) associated with less delay.
The study concluded that when an HF regimen was ordered, patients were more likely to complete therapy without a delay, to complete therapy overall, and if experiencing a delay, to experience a shorter delay. In response to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., remarked, “This study was conceived by HealthHelp and Humana to help us better understand the relationship between the orders for radiation therapy that are placed and the care that patients actually receive. Although it is not surprising that patients with orders for a shorter course of treatment were more likely to complete their treatment, this study plays an important role in demonstrating this empirically. When a physician believes that a patient might benefit equally from hypofractionation and conventional fractionation, consideration should be given to the potentially greater degree of adherence that may occur with a shorter regimen.”
To read this study in its entirety, please click here: https://doi.org/10.1016/j.prro.2019.10.009