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Location: Marriott Marquis
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PQA 10 - PQA 10 Head & Neck Cancer and Health Services Research/Global Oncology Poster Q&A

3630 - Resource Implications of Evolving Breast Cancer Radiotherapy Treatment Protocols

Wednesday, October 2, 2024
10:30 AM – 11:45 AM ET
Location: Hall C

Screen: 29

D. J. Coyle1, B. McClean2, R. Woods3, F. Duane4, and O. McArdle2; 1Beaumont Hospital, Dublin, Ireland, 2St. Luke’s Radiation Oncology Network, Dublin, Ireland, 3St. Lukes Hospital, Dublin, Dublin, Ireland, 4Discipline of Radiation Therapy &Trinity St James’s Cancer Institute, Trinity College Dublin, Dublin, Ireland

Purpose/Objective(s): Breast cancer radiotherapy (RT) represents a significant proportion of workload in RT departments. Hypofractionation has been widely adopted as standard for all women receiving whole breast RT. We used activity-based costing to evaluate the impact of treatment protocol changes on planning and treatment delivery costs. Materials/

Methods: We identified treatment protocol changes by reviewing a recent update of our institutional breast cancer treatment guideline and by consultation with physicians. Our retrospective cohort included 224 women treated with adjuvant RT for breast cancer in our institution January-July 2019. We recorded the time for each task, the staff involved and the staff salary grades. Infrastructure cost per Gy was calculated based on linear accelerator cost of €2.5M, 10% annual service charge over 12-year lifetime with 2.7 patients treated per hour, giving €37.72 per Gy. Based on the assignment of each patient to the appropriate treatment protocol change, the difference between resources required to deliver treatment before and after the implementation of protocol changes was calculated (Figure 1).
Results: The cost of treating the cohort after all treatment changes were applied was €479,323, a reduction of €62,477 (11.5%) from baseline. The implementation of hypofractionation 26Gy/5 resulted in the largest cost reduction of €47,489. After applying all changes, the total linac time to treat the cohort was 65,150 mins. This represents an overall reduction in linac time used of 9,700 mins (12.9%). Non linac staff time was reduced by 1,315 mins (1.1%).
Conclusion: Our study demonstrated that combined changes in breast cancer adjuvant RT treatment protocols, introduced as a result of updated clinical guidelines, resulted in a saving in staff time and overall resource cost. Abstract 3630 – Table 1
Treatment protocol Total linac time (mins) Non linac staff time (mins) Total Resource € Total infrastructure € Total cost €
Treatment as given 74,850 119,025 136,104 405,696 541,800
40Gy/15 for patients with reconstruction (instead of 50Gy/25) 72,650 118,565 133,848 401,924 535,771
Difference - 2,200 - 460 - 2,256 - 3,772 - 6,028
Protocol defined use of boost 69,800 114,875 129,153 384,802 513,956
Difference - 2,850 - 3,690 - 4,694 - 17,121 - 21,815
26Gy/5 for non-nodal RT, no boost 58,700 112,155 117,574 348,893 466,467
Difference - 11,100 - 2,720 - 11,579 - 35,909 - 47,489
Boost for DCIS patients meeting inclusion criteria for TROG DCIS Trial 59,100 112,690 118,242 351,411 469,653
Difference 400 535 668 2,518 3,186
IMN treatment for all with N2 disease and N1 disease with risk factors 63,225 119,910 125,854 351,411 477,265
Difference 4,125 7,220 7,612 - 7,612
DIBH for all < 60 yrs left sided, <60 yrs right sided IMN, constraints not met on FB plan 65,150 120,340 127,912 351,411 479,323
Difference 1,925 430 2,058 - 2,058
Total difference from baseline - 9,700 mins - 1,315 mins - €8,192 - €54,285 -€62,477
% change -12.96% -1.10% -6.02% -13.38% -11.53%