Hypofractionated whole breast irradiation for early stage breast cancer in a large community-based physician practice

Hypofractionated whole breast irradiation has been found, in clinical trials, to be a clinically efficacious short course of treatment for patients with early stage breast cancer treated with breast-conserving surgery that is underused in the USA as compared to Canada and the UK. The purpose of this study was to examine the use of hypofractionated whole breast irradiation over time in a large, multistate privately owned, community-based radiation oncology practice in the USA. Bivariate and multivariate analyses were used. A logistic regression model was developed to identify an association between patient, tumor and nonclinical factors, and the odds of receiving hypofractionation whole breast irradiation in a group of patients who would be appropriate for this treatment. The use of hypofractionated whole breast irradiation increased over time, but the overall rate in 2013 remained quite low at 8.7 %. Additionally, the factors associated with the use of this treatment were nonclinical in nature and included advanced age and region of the USA. The use of hypofractionated whole breast irradiation has been found to be slowly increasing in the USA; however, it remains low. Additional studies are needed to evaluate the use of incentives with which to encourage the use of this cost-effective and efficacious treatment in the USA.