Authors: Torres MA, Gogineni K, Howard DH
Title: Intensity-modulated radiation therapy in breast cancer patients following the release of a Choosing Wisely recommendation.
Journal: J Natl Cancer Inst :-
Date: 2019 Oct 24
PubMed ID: 31647560
Abstract: In 2013, the American Society for Radiation Oncology recommended against the routine use of intensity-modulated radiation therapy (IMRT) in breast cancer patients. We evaluated trends in the use of IMRT before and after the release of the recommendation. Using SEER-Medicare data, we identified 13,457 breast cancer patients diagnosed between 2012 and 2015 who received breast conserving surgery and post-surgery, whole breast, IMRT or three dimensional conformal radiotherapy. We find that the use of IMRT decreased by 4.6 (95% CI: 3.6 to 5.6; two-sided p < 0.001) percentage points in hospital-based clinics. In freestanding radiotherapy clinics, which had baseline rates of IMRT use that were over 20 percentage points higher than in hospital-based clinics, use of IMRT declined by 6.1 (95% CI: 3.5 to 8.7; two-sided p < 0.001) percentage points. Use of IMRT declined following the release of the recommendation, but a large share of patients treated in freestanding clinics continue to receive IMRT.