title: Patient preferences and physician practice patterns regarding breast radiotherapy.
abstract: OBJECTIVE
  There are multiple current strategies for breast radiotherapy (RT). The alignment of physician practice patterns with best evidence and patient preferences will enhance patient autonomy and improve cancer care. However, there is little information describing patient preferences for breast RT and physician practice patterns.
  
  
  METHODS
  Using a reliable and valid instrument, we assessed the preferences of 5,000 randomly selected women (with or without cancer) undergoing mammography. To assess practice patterns, 2,150 randomly selected physician-members of American Society for Radiation Oncology were surveyed.
  
  
  RESULTS
  A total of 1,807 women (36%) and 363 physicians (17%) provided usable responses. The 95% confidence interval is < ± 2.3% for patients and < ± 5.3% for physicians. Patient preferences were hypofractionated whole breast irradiation (HF-WBI) 62%, partial breast irradiation (PBI) 28%, and conventionally fractionated whole breast irradiation (CF-WBI) 10%. By comparison, 82% of physicians use CF-WBI for more than 2/3 of women and 56% never use HF-WBI. With respect to PBI, 62% of women preferred three-dimensional (3D)-PBI and 38% favor brachytherapy-PBI, whereas 36% of physicians offer 3D-PBI and 66% offer brachytherapy-PBI. 70% of women prefer once-daily RT over 10 days vs. twice-daily RT over 5 days. 55% of physicians who use PBI do not offer PBI on clinical trial.
  
  
  CONCLUSIONS
  HF-WBI, while preferred by patients and supported by evidence, falls behind the unproven and less preferred strategy of PBI in clinical practice. There is a discrepancy between women's preferences for PBI modality and type of PBI offered by physicians. Further alignment is needed between practice patterns, patient preferences, and clinical evidence.
authors.affiliation: Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, WPAFB, OH, USA. david.hoopes@wpafb.af.mil
authors.forename: David J
authors.initials: DJ
authors.lastname: Hoopes
authors.forename: David
authors.initials: D
authors.lastname: Kaziska
authors.forename: Patrick
authors.initials: P
authors.lastname: Chapin
authors.forename: Daniel
authors.initials: D
authors.lastname: Weed
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: E Ronald
authors.initials: ER
authors.lastname: Hale
authors.forename: Peter A
authors.initials: PA
authors.lastname: Johnstone
mesh_terms: D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000532:radiotherapy*; D016001:Confidence Intervals; D003710:Demography; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D057240:Patient Preference / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018787:Radiation Oncology / Q000706:statistics & numerical data*; D020266:Radiotherapy, Conformal / Q000379:methods / Q000706:statistics & numerical data; D012955:Societies, Medical; D014481:United States