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Effect of Virtual Tumor Board Implementation on Use of Whole-Breast Hypofractionated Radiation Therapy


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In an observational cohort study reported in JCO Oncology Practice, Powell et al found that the use of whole-breast hypofractionated radiotherapy increased among patients with breast cancer with health insurance plans from one national health-care organization after the implementation of a virtual tumor board.

As stated by the investigators, “The virtual tumor board is a multidisciplinary group of specialist physicians who remotely educate the treating physician on the development of an evidence-based cancer treatment plan that will enhance patient outcomes according to the available literature. The use of hypofractionated radiotherapy is a preferred approach according to National Comprehensive Cancer Network® guidelines and is encouraged by the virtual tumor board, when appropriate.”

“After the virtual tumor board was implemented, there was a significant increase in hypofractionated radiotherapy orders and claims.”
— Powell et al

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Study Details

The study used prior authorization and claims data for patients with health insurance plans from one national health-care organization. Orders and claims for qualifying patients from the year before the virtual tumor board was initiated (August 1, 2016 to July 31, 2017) and the year after the virtual tumor board was initiated (August 1, 2017 to July 31, 2018) were extracted. Claims were examined to determine which patients received conventional fractionated (28–35 fractions) vs hypofractionated (15–21 fractions) radiotherapy. In total, 3,978 patients were included in the order analysis and 3,193 were included in the claims analysis.

Odds ratios (ORs) were adjusted for age, urbanicity, local average income, and radiotherapy modality used.

Key Findings

After virtual tumor board implementation, the percentage of orders for hypofractionated radiotherapy increased significantly, from 53.2% (n = 1,010 of 1,899) to 60.3% (n = 1,254 of 2,079), with an odds ratio of 1.35 (95% confidence interval [CI] = 1.19–1.54, P < .001).

After virtual tumor board implementation, claims for hypofractionated radiotherapy increased from 59.0% (n = 941 of 1,595) to 71.5% (n = 1,143 of 1,598), with an odds ratio of 1.76 (95% CI = 1.52–2.04, P < .001).

Additional factors significantly associated with reduced likelihood of having orders and claims for hypofractionated radiotherapy were:

  • Younger age (OR = 1.05 for each year increase for orders; OR = 1.03 for each year increase for claims)
  • Residence in a ZIP code with average income of less than $40,000 per year (ORs = 0.79 and 0.78, respectively)
  • Having Medicare vs commercial insurance (ORs = 0.71 and 0.60, respectively)
  • Having intensity-modulated radiotherapy vs 2D/3D conformal radiotherapy as the designated modality (ORs = 0.38 and 0.37, respectively).

The investigators concluded, “After the virtual tumor board was implemented, there was a significant increase in hypofractionated radiotherapy orders and claims.”

Adam C. Powell, PhD, of HealthHelp, Houston, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by HealthHelp and Humana. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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