When Less is More in Radiation Oncology

August 8, 2023

Through greater use of hypofractionation, Evolent and a health plan partner reduced unnecessary radiation treatments without compromising efficacy for patients with breast cancer.

For some breast cancer patients requiring radiation therapy, there's a treatment approach that spares them from weeks of daily clinic visits, lowers their out-of-pocket costs and reduces health plan spending—all without compromising efficacy.

Called hypofractionation, it delivers the same total dose as conventional radiotherapy but over fewer sessions. One study found that health plans spent nearly $6,400 less for patients receiving these shortened courses, and patients saved about $140, aside from travel-associated costs. Critically, evidence has shown the approach to be equivalent to standard radiation therapy for local control and overall survival, and superior for toxicity, patient adherence and well-being.

Still, while medical societies have endorsed shortened courses of radiotherapy for both breast and prostate cancer, adoption has lagged in the U.S. So, Evolent and our partners at a regional health plan launched an initiative in late 2020 to increase adoption.

The Intervention

To increase hypofractionation use, Evolent adjusted its high-value clinical oncology pathways to make it the default selection for lymph node-negative post-lumpectomy patients, a common scenario. Requests for these shortened courses—calling for 16-21 treatments as opposed to the 33 treatments in conventional courses—receive automatic approval. When providers seek to deviate or get a clinical exception from that preferred approach, it triggers a peer review discussion with an Evolent radiation oncology expert. The Evolent expert gets details about the case and presents evidence supporting hypofractionation, which often leads the oncologist to change the request to the recommended shorter treatment.

Steady Improvement

The intervention produced steady improvement in use of hypofractionation with eligible breast patients—from 40% in September 2020 through 61% in July 2022. The results, presented by Evolent and health plan researchers on March 31 at the National Comprehensive Cancer Care Network conference, spanned 19 providers in nine practices.

The results have implications not only for reducing "time toxicity" from patients spending excessive time interacting with the health care system, but also decreasing patient copays and travel expenses.

Today, the strategies that Evolent used to increase hypofractionation with this regional plan are in place across all our health plan partners.

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