An article titled, “Rate of Whole Breast Hypofractionated Radiation Therapy Pre- Versus Post-Virtual Tumor Board Implementation” has been published by JCO Oncology Practice, an American Society of Clinical Oncology (ASCO) journal. A poster related to the study was previously accepted for presentation at the National Consortium of Breast Centers 2020 Interdisciplinary Breast Center Conference. The study was jointly conducted by HealthHelp and Humana as a part of the ongoing research alliance between the organizations.

The Virtual Tumor Board (VTB) is a multidisciplinary group of specialist physicians who remotely work to educate the treating physician on the development of a cancer treatment plan that will enhance patient outcomes, based upon the available peer-reviewed literature. The physicians on the VTB have expertise in radiation therapy, chemotherapy, and surgical oncology, and six are specialists in breast cancer. The physicians on the VTB practice medicine at a variety of facilities across the country, and are part-time contractors of the specialty benefits management company operating the VTB. During quarterly meetings, the members of the VTB develop a consensus on the types of treatment plans that should be recommended to physicians. According to the National Comprehensive Cancer Network guidelines, the use of hypofractionated (HF) radiation therapy (RT) is a preferred approach for the treatment of breast cancer after breast-conserving surgery. Thus, HF RT is encouraged by the VTB when appropriate.

The study’s purpose was to show how the relative use of HF RT and conventional fractionated (CF) RT changed after the implementation of the VTB.The study utilized an observational, historical cohort design and was conducted using prior authorization and administrative claims data. Orders and claims for qualifying patients from one year pre-implementation of the VTB (8/2016) to one year post-implementation of the VTB (8/2018) were extracted from the applicable databases. Patients were excluded if they resided where the VTB was piloted, were not continuously enrolled in their health plan for 70 days following their RT order, had a mastectomy, positive lymph nodes, were aged 90 or older, or had a number of fractions not consistent with HF RT (15-21) or CF RT (28-35). RT claims for patients occurring more than 70 days after their orders were excluded from the study. Claims in the 70 days following the order were examined to determine which patients received HF RT versus CF RT. Chi-square tests were used to assess the association between time period and the ordering and use of HF RT. Logistic regressions were used to test the association, after adjusting for the patient’s age, urbanicity, residence in a ZIP code with average income <$40,000, and the RT modality used.

Following implementation, we observed a significantly higher percentage of orders for HF RT (60.3% [1,254/2,079] vs. 53.2% [1,010/1,899], P<.001) and a significantly higher percentage of claims for HF RT (71.5% [1,143/1,598] vs. 59.0% [941/1,595], P<.001). Relative to pre-implementation, the adjusted odds of an order for HF RT was 1.35 (confidence interval [CI]: 1.19-1.54), and the adjusted odds of claims for HF RT was 1.76 (CI: 1.52-2.04). HF RT orders were negatively and significantly associated with younger age, residing in a lower income ZIP code, having Medicare Advantage, and the use of intensity-modulated RT. These same associations were significant in the claims analysis.

The study found that after the implementation of the VTB, there was a significant increase in both orders for HF RT and claims for HF RT. Reacting to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., commented, “This study demonstrates that the radiation therapy patients received changed after the implementation of the Virtual Tumor Board. Hypofractionated radiation therapy was more frequently used in the year following implementation. The Virtual Tumor Board program has the potential to educate physicians across the country about best practices, and to provide them with the opportunity to speak with specialists that might otherwise be inaccessible to them. Our prior research has found that the use of hypofractionated radiation therapy is associated with greater treatment completion. Thus, the Virtual Tumor Board has been recommending, where appropriate, the use of an approach to care that we have shown leads to better quality outcomes.”

To read the article, please visit: https://ascopubs.org/doi/abs/10.1200/OP.20.00480

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