Understanding variations in the use of hypofractionated radiotherapy and its specific indications for breast cancer: A mixed-methods study.

Autor: Prades J; Catalonian Cancer Strategy, Department of Health, Barcelona, Spain., Algara M; Department of Radiation Oncology, Parc de Salut Mar. University Pompeu Fabra (UPF). Hospital del Mar Medical Research Institute (IMIM). Barcelona, Spain., Espinàs JA; Catalonian Cancer Strategy, Department of Health, Barcelona, Spain., Farrús B; Department of Radiation Oncology, Hospital Clínic, Barcelona, Spain., Arenas M; Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Spain; University of Rovira and Virgili (URV), Reus, Spain., Reyes V; Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain., García-Reglero V; Department of Radiation Oncology, Hospital Arnau de Vilanova, Lleida, Spain., Cambra MJ; Department of Radiation Oncology, Institut Oncològic del Vallés, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Terrassa, Spain., Rubio E; Department of Radiation Oncology, Institut Oncològic del Vallés, Consorci Sanitari de Terrassa, Spain., Anglada L; Dept. of Radiation Oncology, Catalan Institut of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain., Eraso A; University of Barcelona (IDIBELL), Spain; Department of Radiation Oncology, Catalan Institute of Oncology, L'Hospitalet, Spain., Pedro A; Department of Radiation Oncology, Hospital Plató, Barcelona, Spain., Fuentes-Raspall MJ; Department of Radiation Oncology, Sant Pau Hospital, Barcelona, Spain., Tuset V; Department of Radiation Oncology, ICO Badalona. Hospital Universitari Germans Trias i Pujol; Badalona, Spain., Solà J; Catalonian Cancer Strategy, Department of Health, Barcelona, Spain., Borras JM; Catalonian Cancer Strategy, Department of Health, Barcelona, Spain; University of Barcelona (IDIBELL), Spain. Electronic address: jmborras@iconcologia.net.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2017 Apr; Vol. 123 (1), pp. 22-28. Date of Electronic Publication: 2017 Feb 21.
DOI: 10.1016/j.radonc.2017.01.014
Abstrakt: Background and Purpose: Radiation oncology guidelines favour hypofractionated whole-breast radiotherapy (HWBRT) over more conventional schemes in the conservative treatment of breast cancer, but its adoption still varies in clinical practice. This study assessed the patterns of HWBRT adoption in Catalonia (Spain).
Material and Methods: We used a mixed-methods approach based on an explanatory sequential design, first collecting and analysing quantitative data on HWBRT use (>2.5Gy per fraction) in 11 public radiotherapy centres (2005-2015) and then performing 25 semi-structured interviews with all department heads and reference radiation oncologist/s.
Results: Of the 34,859 patients fulfiling the study criteria over the study period, just 12% were hypofractionated, reaching a percentage of 29% in 2015 (p<0.001). Our analysis showed a narrowing age gap between patients receiving conventional fractionation and hypofractionation in centres leading adoption. However, there were important differences in clinicians' interpretation of evidence (e.g. regarding the perceived risk of long-term toxicity) and selection of patients for specific indications, both within and between departments.
Conclusions: Differences observed in the rate of adoption of HWBRT could not be tackled only using a rational, evidence-based approach. Factors related to the management of radiotherapy departments play a major role in the diffusion of therapeutic strategies.
(Copyright © 2017 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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