Princess Margaret Cancer Center, University Health Network Toronto, ON
G. T. Y. Ko1, A. Roberts2, Q. Li3, N. Liu3, T. Zhong4, E. Amir5, A. Koch6, A. Covelli7, V. Freitas8, A. Eskander9, and T. Cil1; 1Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 2Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 3IC/ES, Toronto, ON, Canada, 4Division of Plastic and Reconstructive Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 5Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 6Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 7Division of General Surgery, Sinai Health System - Mount Sinai Hospital, Toronto, ON, Canada, 8Breast Imaging Division, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada, 9Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Purpose/Objective(s): During the COVID-19 pandemic, the five daily fraction FAST-Forward radiation protocol was adopted in Ontario for treating early-stage breast cancer (BC), which also minimized healthcare visits. However, there has been limited data about how this regimen was adopted at a population level. We hypothesize that there is regional variability with respect to adoption of this new radiation protocol. Materials/
Methods: We identified visits for radiation therapy to the breast between January 1, 2018 and December 31, 2022 at the 16 regional cancer centres in Ontario, Canada. Radiation regimens were classified into three protocols based on the initial treatment dose (conventional (CONV), moderate hypofractionation (HF), FAST-Forward, or other). The characteristics of patients, including the cancer centre where they received treatment, were explored. Results: There were 22,757 patients who received radiation to the breast during the study period. Patients began being treated with the FAST-Forward regimen in March 2020 and 2,092 (9.2%) were treated with this protocol. The percentage of patients treated on the FAST-Forward protocol at each centre ranged from 0 – 29.6%. Patients who received the FAST-Forward protocol were older (mean age = 67.6 + 9.9) compared to patients who received HF (61.1 + 11.3) or CONV treatment regimen (58.2 + 12.6; p <0.001). Additionally, 96.0% of patients who had the FAST-Forward regimen had breast conserving surgery and 83.8% had stage 1 or 2 BC. Conclusion: In this large population study, we identified variable adoption of the FAST-Forward protocol for BC adjuvant treatment across Ontario. Future studies assessing reasons for slow adoption and potential cost/visits to encourage utilization of the FAST-Forward regimen for suitable patients with early-stage BC should be explored.
