| Title |
Choosing wisely after publication of level I evidence in breast cancer radiotherapy
|
|---|---|
| Published in |
Breast cancer targets and therapy, February 2018
|
| DOI | 10.2147/bctt.s153117 |
| Pubmed ID | |
| Authors |
Joshua R Niska, Sameer R Keole, Barbara A Pockaj, Michele Y Halyard, Samir H Patel, Donald W Northfelt, Richard J Gray, Nabil Wasif, Carlos E Vargas, William W Wong |
| Abstract |
Recent trials in early-stage breast cancer support hypofractionated whole-breast radiotherapy (WBRT) as part of breast-conserving therapy (BCT). Evidence also suggests that radiotherapy (RT) omission may be reasonable for some patients over 70 years. Among radiation-delivery techniques, intensity-modulated RT (IMRT) is more expensive than 3-dimensional conformal RT (3DCRT). Based on this evidence, in 2013, the American Society for Radiation Oncology (ASTRO) recommended hypofractionated schedules for women aged ≥50 years with early-stage breast cancer and avoiding routine use of IMRT for WBRT. To assess response to level I evidence and adherence to ASTRO recommendations, we evaluated the pattern of RT use for early-stage breast cancer at our National Comprehensive Cancer Network institution from 2006 to 2008 and 2011 to 2013 and compared the results with national trends. Data from a prospective database were extracted to include patients treated with BCT, aged ≥50 years, with histologic findings of invasive ductal carcinoma, stage T1-T2N0M0, estrogen receptor-positive, and HER2 normal. We retrospectively reviewed the medical records and estimated costs based on 2016 Hospital Outpatient Prospective Payment System (technical fees) and Medicare Physician Fee Schedule (professional fees). Among 55 cases from 2006 to 2008, treatment regimens were 11% hypofractionated, 69% traditional schedule, and 20% RT omission (29% of patients were aged >70 years). Among 83 cases from 2011 to 2013, treatment regimens were 54% hypofractionated, 19% traditional schedule, and 27% RT omission (48% of patients were aged >70 years). 3DCRT was used for all WBRT treatments. Direct medical cost estimates were as follows: 15 fractions 3DCRT, $7,197.87; 15 fractions IMRT, $11,232.33; 25 fractions 3DCRT, $9,731.39; and 25 fractions IMRT, $16,877.45. Despite apparent resistance to shorter radiation schedules in the United States, we demonstrate that rapid practice change in response to level I evidence is feasible. Wider adoption of evidence-based guidelines in early-stage breast cancer may substantially lower health care costs and improve convenience for patients without sacrificing oncologic outcomes. |
X Demographics
The data shown below were collected from the profiles of 10 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 4 | 40% |
| United Kingdom | 3 | 30% |
| Unknown | 3 | 30% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 8 | 80% |
| Practitioners (doctors, other healthcare professionals) | 2 | 20% |
Mendeley readers
The data shown below were compiled from readership statistics for 26 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 26 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Other | 6 | 23% |
| Researcher | 3 | 12% |
| Student > Ph. D. Student | 2 | 8% |
| Student > Postgraduate | 2 | 8% |
| Professor > Associate Professor | 2 | 8% |
| Other | 4 | 15% |
| Unknown | 7 | 27% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 10 | 38% |
| Engineering | 2 | 8% |
| Economics, Econometrics and Finance | 2 | 8% |
| Business, Management and Accounting | 1 | 4% |
| Physics and Astronomy | 1 | 4% |
| Other | 1 | 4% |
| Unknown | 9 | 35% |
Attention Score in Context
This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 18 April 2022.
All research outputs
#5,391,140
of 25,382,440 outputs
Outputs from Breast cancer targets and therapy
#79
of 324 outputs
Outputs of similar age
#110,645
of 448,849 outputs
Outputs of similar age from Breast cancer targets and therapy
#3
of 5 outputs
Altmetric has tracked 25,382,440 research outputs across all sources so far. Compared to these this one has done well and is in the 78th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 324 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.0. This one has done well, scoring higher than 75% of its peers.
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