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Title: Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis

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% andmore » 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.« less

Authors:
 [1];  [2];  [3];  [4];  [1];  [5];  [3];  [6]
  1. Department of Radiation Oncology, Robert Wood Johnson Medical School/Cancer Institute of New Jersey, New Brunswick, New Jersey (United States)
  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 (United States)
  5. Michigan HealthCare Professionals, Farmington Hills, Michigan (United States)
  6. Rutgers University School of Business, Newark, New Jersey (United States)
Publication Date:
OSTI Identifier:
22645765
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 97; Journal Issue: 2; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; FRACTIONATED IRRADIATION; MAMMARY GLANDS; MARKOV PROCESS; PATIENTS; RADIOTHERAPY; SENSITIVITY ANALYSIS; WOMEN

Citation Formats

Khan, Atif J., E-mail: atif.j.khan@rutgers.edu, Rafique, Raza, Zafar, Waleed, Shah, Chirag, Haffty, Bruce G., Vicini, Frank, Jamshed, Arif, and Zhao, Yao. Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis. United States: N. p., 2017. Web. doi:10.1016/J.IJROBP.2016.10.002.
Khan, Atif J., E-mail: atif.j.khan@rutgers.edu, Rafique, Raza, Zafar, Waleed, Shah, Chirag, Haffty, Bruce G., Vicini, Frank, Jamshed, Arif, & Zhao, Yao. Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis. United States. doi:10.1016/J.IJROBP.2016.10.002.
Khan, Atif J., E-mail: atif.j.khan@rutgers.edu, Rafique, Raza, Zafar, Waleed, Shah, Chirag, Haffty, Bruce G., Vicini, Frank, Jamshed, Arif, and Zhao, Yao. Wed . "Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis". United States. doi:10.1016/J.IJROBP.2016.10.002.
@article{osti_22645765,
title = {Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis},
author = {Khan, Atif J., E-mail: atif.j.khan@rutgers.edu and Rafique, Raza and Zafar, Waleed and Shah, Chirag and Haffty, Bruce G. and Vicini, Frank and Jamshed, Arif and Zhao, Yao},
abstractNote = {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.},
doi = {10.1016/J.IJROBP.2016.10.002},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 97,
place = {United States},
year = {Wed Feb 01 00:00:00 EST 2017},
month = {Wed Feb 01 00:00:00 EST 2017}
}