Experts from South Korea, Japan, Singapore and Australia assess current challenges and opportunities
Hypofractionated radiotherapy treatments deliver higher per-fraction radiation doses over fewer treatments than traditional radiotherapy. As reported in JCO® Global Oncology, hypofractionated radiotherapy has become the standard of care for breast and prostate cancer patients in the United States and Europe, with studies suggesting that outcomes are noninferior to conventional radiotherapy, while treatment durations are shorter and at a lower cost to health systems.1
“Hypofractionation—when it is indicated—is better for everyone. Better for the patients, whose treatment regimens end sooner; better for the health care providers, who can reduce the cost of treatment per patient and potentially serve more patients,” said Dr. Ricky Sharma, Vice President Clinical Affairs at Varian. “Unfortunately, the adoption of this approach has not been widespread across the Asia-Pacific region, as reflected in a global study that highlighted disparities across the region in the treatment of breast cancer and prostate cancer.2 And so, over a two-year period, we looked for ways to address this lack of access for patients in this region.”
To assess the adoption of—and access to—hypofractionated radiotherapy in Japan, Australia, Singapore, and South Korea, renowned radiation oncologists from each country came together in a collaborative initiative, the Therapy Advancement Thought Leadership Council (TA-TLC), supported by Varian.
One of the key objectives of this international group of experts was to explore ways to enhance the adoption of advanced therapies across the Asia-Pacific region, including ultra-hypofractionated methods, such as stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT).
The TA-TLC collaborative initiative also gave participating experts the opportunity for cross learning on clinical, reimbursement and administrative best practices, as well as identifying barriers to adoption and potential solutions. By reaching consensus on the key issues, the group published their expert opinions in the ASTRO journal, Advances in Radiation Oncology.3
In the paper, entitled “Challenges and Opportunities with the Use of Hypofractionated Radiation Therapy in Cancer Care: Regional Perspectives from South Korea, Japan, Singapore, and Australia,” the experts focus on brain, breast, lung, and prostate tumor sites and share their perspectives on ways to improve adoption. One of the main barriers identified is reimbursement models used by payers, which vary by country but are often still based on traditional per-fraction models that have not kept up with technical and clinical advances in number of fractions and treatment schedules that can be used to benefit patients.
For instance, the authors note: “Pay-per-fraction models in countries such as Japan disincentivize physicians to choose shorter treatment schedules and remove the physicians’ flexibility to choose the optimal treatment platform and the number of fractions best suited to the patient.”
Another key hurdle identified by experts is the referral pathways, with general physicians and surgeons often acting as gatekeepers for patient referrals to radiation oncologists, which can limit information about radiation therapy options available to the patient and hinder a broader multidisciplinary approach to cancer care.
The authors state: “In our experience, surgeons often present limited information to patients about radiation therapy and do not always refer patients to radiation oncology specialists, indicating discrepancies in hospital policies and referral pathways.”
Other barriers discussed in the paper include limited resources, technology, and administrative capabilities, and concern about the potential toxicity and side effects associated with hypofractionation. In each case, the panel proposed solutions based on their own observations, from reworking remuneration models to increasing local clinical trial data, patient advocacy, and applying lessons from the COVID-19 pandemic.
The experts conclude: “It is critical to uphold the role of radiation oncologists within the multidisciplinary team in advocating for patients, educating peers on data, and facilitating effective treatment decision-making to ensure patients benefit from this significant advancement in modern radiation therapy.”
For more details, read the full paper.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166538
- Rodin D, Tawk B, Mohamad O, et al. Hypofractionated radiother-apy in the real-world setting: An international ESTRO-GIRO survey. Radiother Oncol. 2021;157:32-39.
- https://www.advancesradonc.org/article/S2452-1094(23)00120-3/fulltext