Atif J Khan1, Raza Rafique2, Waleed Zafar3, Chirag Shah4, Bruce G Haffty5, Frank Vicini6, Arif Jamshed3, Yao Zhao7. 1. Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey. Electronic address: atif.j.khan@rutgers.edu. 2. Suleman Dawood School of Business, Lahore University of Management Sciences, Lahore, Pakistan. 3. Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. 4. Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio. 5. Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey. 6. Michigan HealthCare Professionals, Farmington Hills, Michigan. 7. Rutgers University School of Business, Newark, New Jersey.
Abstract
PURPOSE: Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. METHODS AND MATERIALS: We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. RESULTS: The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. CONCLUSIONS: Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.
PURPOSE: Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system. METHODS AND MATERIALS: We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population. RESULTS: The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model. CONCLUSIONS: Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.
Authors: Krishan R Jethwa; Sean S Park; Karthik Gonuguntla; Stephanie M Wick; Laura A Vallow; Christopher L Deufel; Thomas J Whitaker; Keith M Furutani; Kathryn J Ruddy; Kimberly S Corbin; Tina J Hieken; Robert W Mutter Journal: Int J Radiat Oncol Biol Phys Date: 2018-12-21 Impact factor: 7.038
Authors: Chirag Shah; Martin Keisch; Atif Khan; Douglas Arthur; David Wazer; Frank Vicini Journal: Ann Surg Oncol Date: 2021-01-13 Impact factor: 5.344
Authors: Matthew M Poppe; Zeinab A Yehia; Christopher Baker; Sharad Goyal; Deborah Toppmeyer; Laurie Kirstein; Chunxia Chen; D F Moore; Bruce G Haffty; Atif J Khan Journal: Int J Radiat Oncol Biol Phys Date: 2020-04-11 Impact factor: 7.038