Trends in utilization of hypofractionated whole breast radiation in breast cancer: An analysis of the National Cancer Database.

Abstract

536 Background: Utilization of hypofractionated radiation (HR) as a component of breast conserving treatment (BCT) in breast cancer is lacking in the U.S. despite studies demonstrating its efficacy and guidelines supporting its use from the American Society for Radiation Oncology (ASTRO) in 2011 and 2018. Little is known regarding national trends in uptake and factors associated with uptake of HR in the U.S. since the 2011 ASTRO guidelines. Methods: We performed a retrospective review of the National Cancer Data Base (2012-2016) on patients undergoing BCT. Logistic regression modeling was used to identify relationships between patient, hospital, and tumor factors with the use of HR or traditional radiation (TR). Results: A total of 360,834 cases of BCT were identified with 65% (n=235,783) undergoing TR and 35% (n=125,051) undergoing HR. The odds of utilization of HR increased with year of diagnosis, patient age, higher median income, private insurance, treatment at an academic center, travel distance to treatment >20 miles, smaller tumors, lymph node negative disease, and without use of chemotherapy (p-values <0.0001, Table). Conclusions: Despite studies demonstrating the efficacy of its use and the support of ASTRO, HR utilization in the U.S. is still lacking. By understanding which patient populations are still not receiving the benefit of this therapy we can improve our utilization of HR in the U.S. leading to reduced healthcare costs and patient satisfaction. [Table: see text]