Joan Prades1, Manel Algara2, Josep A Espinàs1, Blanca Farrús3, Meritxell Arenas4, Victoria Reyes5, Virginia García-Reglero6, Maria Josep Cambra7, Esther Rubio8, Lluis Anglada9, Arantxa Eraso10, Agustí Pedro11, Maria J Fuentes-Raspall12, Victòria Tuset13, Judit Solà1, Josep M Borras14. 1. Catalonian Cancer Strategy, Department of Health, Barcelona, Spain. 2. Department of Radiation Oncology, Parc de Salut Mar. University Pompeu Fabra (UPF). Hospital del Mar Medical Research Institute (IMIM). Barcelona, Spain. 3. Department of Radiation Oncology, Hospital Clínic, Barcelona, Spain. 4. Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Spain; University of Rovira and Virgili (URV), Reus, Spain. 5. Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain. 6. Department of Radiation Oncology, Hospital Arnau de Vilanova, Lleida, Spain. 7. Department of Radiation Oncology, Institut Oncològic del Vallés, Hospital Universitari General de Catalunya-Grupo Quirónsalud, Terrassa, Spain. 8. Department of Radiation Oncology, Institut Oncològic del Vallés, Consorci Sanitari de Terrassa, Spain. 9. Dept. of Radiation Oncology, Catalan Institut of Oncology, University Hospital Dr. Josep Trueta, Girona, Spain. 10. University of Barcelona (IDIBELL), Spain; Department of Radiation Oncology, Catalan Institute of Oncology, L'Hospitalet, Spain. 11. Department of Radiation Oncology, Hospital Plató, Barcelona, Spain. 12. Department of Radiation Oncology, Sant Pau Hospital, Barcelona, Spain. 13. Department of Radiation Oncology, ICO Badalona. Hospital Universitari Germans Trias i Pujol; Badalona, Spain. 14. Catalonian Cancer Strategy, Department of Health, Barcelona, Spain; University of Barcelona (IDIBELL), Spain. Electronic address: jmborras@iconcologia.net.
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 (>2.5Gy 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.
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 (>2.5Gy 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.
Authors: A Rodríguez; M Arenas; P C Lara; J López-Torrecilla; M Algara; A Conde; H Pérez-Montero; J L Muñoz; P Peleteiro; M J Pérez-Calatayud; J Contreras; C Ferrer Journal: Clin Transl Oncol Date: 2019-04-03 Impact factor: 3.405
Authors: A Rodríguez; M Algara; D Monge; J López-Torrecilla; F Caballero; R Morera; R Escó; H Pérez-Montero; C Ferrer; P C Lara Journal: Clin Transl Oncol Date: 2017-08-03 Impact factor: 3.405
Authors: Y Lupiañez-Perez; J Gomez-Millan; M Lobato; P Pedrosa; I Lupiañez-Perez; J A Medina Journal: Clin Transl Oncol Date: 2017-05-29 Impact factor: 3.405
Authors: Meritxell Arenas; Nam Nguyen; Pierfrancesco Franco; Ugur Selek; Angeles Rovirosa; Sebastia' Sabater Journal: Biomed Res Int Date: 2018-06-07 Impact factor: 3.411