Hello, my name is Sara Booth and I am presenting our research, "Increase in Hypofractionated Radiation Therapy Among Patients with Invasive Breast Cancer or Ductal Carcinoma In Situ: Who is Left Behind?" We're interested in comparing conventional radiation and hypofractionated radiation HF-WBI being characterized by higher doses and shorter duration. It has similar toxicity levels, recurrence rates and disease-free survival compared to the conventional treatment. It is also more cost effective and can improve patient quality of life. However, adoption in the US has been slow but more than doubled between 2013 to 2016. To our understanding, there is no literature looking at post- 2016 trends, despite updated ASTRO guidelines recommending HF-WBI for most patients. Our primary aim was to update the adoption trend using the latest available National Cancer Database data, that includes patients diagnosed through 2020. Our secondary aim was to examine factors associated with utilization to identify subgroups of patients that are less likely to receive this treatment. We found that HF-WBI use has continued to increase over time and by 2020 can finally be considered standard of care in the US. Graph A on the top we see 63.9% use among invasive breast cancer patients. In graph B on the bottom, 56.6% among DCIS patients. In terms of our secondary aim, "Who is Left Behind?," we saw a monotonic increasing trend with age, where younger patients were less likely to receive HF-WBI than older patients. In the invasive breast cancer cohort, we saw that Black patients were less likely than their White counterparts to receive HF-WBI, as well as patients with more advanced stage cancer.
For both groups in terms of facility characteristics, we saw that patients in the South Atlantic and West South Central US census regions were less likely to receive HF-WBI. Additionally, patients at smaller centers and Community Cancer Programs were less likely to receive this treatment. We found that HF-WBI is finally standard of care, but there are substantial disparities in adoption for both invasive breast cancer and DCIS patients, and given its cost-effectiveness regarding both time and money, HF-WBI does have the potential to improve radiation completion rates and reduce disparities in breast cancer outcomes. We identified a need for promotion of HF-WBI for patients at community centers and centers in the South Atlantic and West South-Central regions. We also noted that low uptake among younger patients, and despite updated ASTRO guidelines that reflect new research in younger patients, this may not be reaching the clinicians who do treat these younger patients. And among invasive breast cancer patients, Black women were significantly less likely to receive HF-WBI than White patients, even after controlling for covariates. And this is in line with literature showing that Black patients experience disparate access to improvements in cancer treatment. Further research is needed to better understand the barriers that Black women face in accessing HF-WBI and improved cancer care in general. Additionally, research is needed to explore the impact of COVID-19 on the adoption trend of HF-WBI, using data beyond 2020. And research is needed to explore how financial incentives for physicians and hospitals may impact the adoption of hypofractionated radiation. Thank you.
