Geographic disparity in the use of hypofractionated radiotherapy among elderly women undergoing breast conservation for invasive breast cancer

Publication date: Available online 12 May 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Erin F. Gillespie, Rayna K. Matsuno, Beibei Xu, Daniel P. Triplett, Lindsay Hwang, Isabel J. Boero, John P. Einck, Catheryn Yashar, James D. Murphy
PurposeResearch demonstrates that the use of short-course (hypofractionated) radiotherapy (RT) breast cancer in the US has lagged behind other countries, despite evidence from randomized trials. This study evaluates geographic heterogeneity in the delivery of hypofractionated radiotherapy among Medicare beneficiaries across the US.MethodsWe identified 190,193 patients from the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Warehouse. The study included patients over age 65 diagnosed with invasive breast cancer treated with breast conservation surgery followed by radiation diagnosed between 2000 and 2012. We analyzed data by hospital referral region based on patient residency zip code. The proportion of women who received hypofractionated RT within each region was analyzed over the study period. Multivariable logistic regression models identified predictors of hypofractionated RT.ResultsOver the entire study period we found substantial geographic heterogeneity in the use of hypofractionated radiotherapy. The proportion of women receiving hypofractionated breast RT in individual hospital referral regions varied from 0% to 61%. We found no correlation between the use of hypofractionated RT and urban/rural setting or general geographic region. The proportion of hypofractionated RT increased in regions with higher density of radiation oncologists, as well as lower total Medicare reimbursements.ConclusionsThis study demonstrates substantial geographic heterogeneity in the use of hypofractionated radiotherapy among elderly women with invasive breast cancer treated with lumpectomy in the US. This heterogeneity persists despite clinical data from multiple randomized trials proving efficacy and safety compared to standard fractionation, and highlights possible inefficiency in healthcare delivery.

Teaser

Among 190,193 women age 65 and older undergoing breast conservation for invasive breast cancer in the United States from 2000-2012, the proportion of women receiving hypofractionated radiotherapy (3-4 weeks) varied from 0% to 61%. In the setting of strong data from randomized clinical trials showing efficacy and safety compared to conventionally fractionated breast radiotherapy (5-7 weeks), the slow uptake of hypofractionated breast radiotherapy coupled with geographic heterogeneity suggests inefficiency in our health care system.


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