Effect of Peer Review Within a Cancer Care Network on Use of Hypofractionated Radiotherapy for Early-Stage Breast Cancer


Key Points

  • Use of hypofractionated radiotherapy varied widely among community-based affiliates.
  • After implementation of peer review, use of hypofractionated radiotherapy increased from 51% to 69% at community-based affiliates.

In a study reported in the Journal of Oncology Practice, Ganju et al found that implementation of a cancer care network–wide peer review process aimed at standardizing treatment resulted in increasing use of hypofractionated radiotherapy in early-stage breast cancer at community-based affiliates of a tertiary care academic medical center.

The study involved data from 349 consecutive patients treated with whole-breast radiation therapy from January 2016 to June 2017 at the main academic site (University of Kansas Medical Center) or at community-based affiliates. Radiation courses with a dose per fraction of > 2 Gy were considered hypofractionated RT; those with a dose per fraction ≤ 2 Gy were considered conventionally fractionated radiation therapy. A system-wide peer review process aimed at standardizing radiotherapy treatment was instituted in November 2016.

Use of HFRT

All 120 patients treated at the main academic site received hypofractionated radiotherapy. Use of hypofractionated radiotherapy varied significantly among community-based providers (28% to 100%, P <.001). After implementation of a system-wide peer review program, rates of hypofractionation use increased from 66% in January 2016 to 81% in June 2017 across the entire network (P = .001) and from 51% to 69% at community-based affiliates (P = .007). Rates of hypofractionated radiotherapy use continued to increase over time and approached 100% toward the end of the study period.

Factors associated with hypofractionated radiotherapy use on univariate analysis were age, tumor grade, chemotherapy receipt, surgeon type (academic vs community), and treatment after implementation of peer review. On multivariate analysis, treatment after implementation of peer review (P < .001), age (P = .005), tumor grade (P = .013), and surgeon type (P < .001) remained significant predictors of hypofractionated radiotherapy use.

The investigators concluded, “Significant variation persists in the use of [hypofractionated radiotherapy] among providers. Increased awareness and oversight through prospective peer review may be useful in improving compliance to [hypofractionated radiotherapy]. Expanding these efforts to include education of referring surgeons may be helpful.”

Melissa Mitchell, MD, PhD, of the University of Kansas Medical Center, Kansas City, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: The study authors' full disclosures can be found at

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