title: Adoption of hypofractionated whole-breast irradiation for early-stage breast cancer: a National Cancer Data Base analysis.
abstract: OBJECTIVE
  To evaluate the relationship of patient, hospital, and cancer characteristics with the adoption of hypofractionation in a national sample of patients diagnosed with early-stage breast cancer.
  
  
  METHODS
  We performed a retrospective study of breast cancer patients in the National Cancer Data Base from 2004-2011 who were treated with radiation therapy and met eligibility criteria for hypofractionation. We used logistic regression to identify factors associated with receipt of hypofractionation (vs conventional fractionation).
  
  
  RESULTS
  We identified 13,271 women (11.7%) and 99,996 women (88.3%) with early-stage breast cancer who were treated with hypofractionation and conventional fractionation, respectively. The use of hypofractionation increased significantly, with 5.4% of patients receiving it in 2004 compared with 22.8% in 2011 (P<.001 for trend). Patients living ≥50 miles from the cancer reporting facility had increased odds of receiving hypofractionation (odds ratio 1.57 [95% confidence interval 1.44-1.72], P<.001). Adoption of hypofractionation was associated with treatment at an academic center (P<.001) and living in an area with high median income (P<.001). Hypofractionation was less likely to be used in patients with high-risk disease, such as increased tumor size (P<.001) or poorly differentiated histologic grade (P<.001).
  
  
  CONCLUSIONS
  The use of hypofractionation is rising and is associated with increased travel distance and treatment at an academic center. Further adoption of hypofractionation may be tempered by both clinical and nonclinical concerns.
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Elyn H
authors.initials: EH
authors.lastname: Wang
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Medical Oncology, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Mougalian
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rutter
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Evans
authors.affiliation: Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey.
authors.forename: Bruce G
authors.initials: BG
authors.lastname: Haffty
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey and Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Yale School of Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research Center at Yale, New Haven, Connecticut; Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut. Electronic address: james.b.yu@yale.edu.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy*; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D016208:Databases, Factual / Q000706:statistics & numerical data; D019583:Dose Fractionation, Radiation; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D047368:Tumor Burden; D014481:United States / Q000453:epidemiology