PURPOSE: Hypofractionated whole-breast irradiation (HF-WBI) remains underutilized in the United States despite support by multiple clinical trials. We evaluated the success of iterative modifications of our @entity0 clinical pathway on the adoption of HF-WBI in a large, integrated radiation oncology network. METHODS AND MATERIALS: The breast clinical pathway was modified in January 2011 (Amendment 1) to recommend HF-WBI as the first option for @entity1 >= 70 of age with stages 0 to IIA, while maintaining @entity7617 ( @entity7617 ) as a pathway-concordant secondary option. In January 2013 (Amendment 2), the pathway's HF-WBI recommendation was extended to @entity1 >= 50 years of age. In January 2014 (Amendment 3), the pathway mandated HF-WBI as the only pathway-concordant option  in @entity1 >= 50 years of age, and all pathway-discordant plans were subject to peer review  and justification. @entity1 >= 50 years of age with @entity513 in situ or invasive @entity0 who underwent breast conserving surgery and adjuvant WBI were included in this analysis. RESULTS: We identified 5112 @entity1 from 2009 to 2014 who met inclusion criteria. From 2009 to 2012, the overall HF-WBI use rate was 8.3%. Following Amendments 2 and 3 (2013 and 2014, respectively), HF-WBI use significantly increased to 21.8% (17.3% in the community, 39.7% at academic sites) and 76.7% (75.5% in the community, 81.4% at academic sites), respectively (P<.001). Compared to 2009 to 2012, the relative risk of using HF-WBI was 7.9 (95% confidence interval: 7.1-8.6, P<.001) and 10.7 (95% CI: 10.3-11.0, P<.001), respectively, after Amendments 2 and 3, respectively. Age >= 70 and treatment at an academic site increased the likelihood of receiving HF-WBI in 2009 to 2012 and following Amendment 2 (P<.001). CONCLUSIONS: This study demonstrates the transformative effect of a clinical pathway on patterns of care for breast radiation therapy. Although our initial HF-WBI use rate was low (8%-22%) and consistent with national rates, the clinical pathway approach dramatically increased adoption rate to >75%. In contrast to passive guidelines, clinical pathways serve as active tools to promote current best practices.

Clinical Pathways: A Catalyst for the Adoption of  Hypofractionation for Early-Stage XXXX .

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'Women'] @entity7617 :: ('MESH:C563514', 'Disease') :: ['CF', 'conventional fractionation'] @entity0 :: ('MESH:D001943', 'Disease') :: ['breast cancer'] @entity513 :: ('MESH:D044584', 'Disease') :: ['ductal carcinoma']
@entity0 :: (MESH:D001943,Disease) :: ['Breast Cancer']
