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

• Published in: Radiotherapy and oncology 2017-04, Vol.123 (1), p.22-28
• Main Authors: Prades, Joan, Algara, Manel, Espinàs, Josep A, Farrús, Blanca, Arenas, Meritxell, Reyes, Victoria, García-Reglero, Virginia, Cambra, Maria Josep, Rubio, Esther, Anglada, Lluis, Eraso, Arantxa, Pedro, Agustí, Fuentes-Raspall, Maria J, Tuset, Victòria, Solà, Judit, Borras, Josep M
• Format: Article
• Language: English
• Subjects: Aged; Breast cancer; Breast neoplasms; Breast Neoplasms - radiotherapy; Catalonia; Catalunya; Càncer de mama; Dose Hypofractionation; Female; Hematology, Oncology and Palliative Medicine; Humans; Investigació amb mètodes mixtos; Middle Aged; Mixed methods research; Mixed-methods; Oncologia; Oncology; Radiation oncology; Radioteràpia; Radiotherapy; Spain; Treatment Outcome
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2017.01.014

Abstract 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 (>2.5 Gy 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.