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Leveraging implementation science to accelerate adoption of shorter-course radiation for breast and prostate cancer

Dr. Erin Gillespie, MD, MPH headshot

Erin Gillespie, MD, MPH

Funding has been awarded to principal investigator Dr. Erin Gillespie, MD, MPH by the National Cancer Institute (K08CA252640) for “Leveraging implementation science to accelerate adoption of shorter-course radiation for breast and prostate cancer.”

Abstract

The overall goal of this NCI K08 career development proposal is to facilitate Dr. Erin Gillespie’s development into an independent investigator in cancer health services research focusing on strategies to enhance quality and evidence-based care in radiation oncology. This proposal focuses on shortening the course of radiation from 7-9 weeks to 3-5 weeks (called “hypofractionation”) which is associated with equivalent cancer control, improved patient-reported outcomes, and decreased costs in patients with breast and prostate cancer. Nonetheless, adoption has been slow. Dr. Gillespie’s prior work has revealed that the individual radiation oncologist is highly influential in whether patients with breast cancer receive hypofractionation or a longer course of radiation.

The overall hypothesis is that radiation oncologists are the linchpin in radiation treatment decision- making, and that implementation strategies that harness behavioral economics will be most likely to impact practice change. My primary objectives are to 1) identify and characterize positive deviant radiation oncologists (high users of hypofractionation) that will 2) elucidate implementation strategies and associate them with adoption of hypofractionation across various settings, and 3) pilot test a multi-pronged strategy that promotes use of hypofractionation in preparation for a large pragmatic multi-center controlled trial. The rationale that underlies the proposed research and training plan is that, with new knowledge about the levers that drive physician decision-making (beyond knowledge gaps), healthcare leaders and policymakers can optimally design and implement systems that evoke change. Dr. Gillespie will harness the resources and expertise at Memorial Sloan Kettering Cancer Center, where she is a faculty member in the Department of Radiation Oncology and the Center for Health Policy and Outcomes. She is also engaged in research in the community- based setting through the MSK Cancer Alliance. Her training plan has a foundation of implementation science that incorporates large dataset analysis, mixed methods, and behavioral economic theory.

In Aim 1 of the proposed study, the investigators will analyze a Medicare dataset that includes claims linked to prescribing radiation oncologist and organization, and is supplemented by the AMA Masterfile. They will systematically conduct the first-ever evaluation of implementation strategies in radiation oncology using mixed methods. Lastly, in Aim 3 the investigators will develop and pilot test a multi-pronged strategy informed by Aims 1-2 and including audit and feedback.

This proposal, together with the new skills Dr. Gillespie will acquire, will generate new knowledge about the impact of implementation strategies on de-implementation of long-course radiation – key parameters necessary to design optimal strategies to encourage physicians to adopt high value radiation. This will specifically support the development of an implementation strategy that will be tested in a subsequent prospective randomized trial to assess real world efficacy.

Accessible Accordion

✪ Randomized clinical trial of a digital integrative medicine intervention among patients undergoing active cancer treatment (2025) NPJ Digital Medicine

✪ Validation of Patient-Reported Outcomes in Patients With Nonmetastatic Breast Cancer Receiving Comprehensive Nodal Irradiation in the RadComp Trial (2024) International Journal of Radiation Oncology, Biology, Physics

✪ Implementation Strategies to Promote Short-Course Radiation for Bone Metastases (2024) JAMA Network Open

✪ Prophylactic Radiation Therapy Versus Standard of Care for Patients with High-Risk Asymptomatic Bone Metastases: A Multicenter, Randomized Phase II Clinical Trial (2024) Journal of Clinical Oncology

✪ Associations Between Radiation Oncologist Demographic Factors and Segmentation Similarity Benchmarks: Insights From a Crowd-Sourced Challenge Using Bayesian Estimation (2024) JCO Clinical Cancer Informatics

✪ Electro-acupuncture versus battle field auricular acupuncture in breast cancer survivors with chronic musculoskeletal pain: subgroup analysis of a randomized clinical trial (2023) Breast Cancer Research and Treatment

✪ Systematic Review and Meta-analysis of the Association Between Radiation Therapy Treatment Volume and Patient Outcomes (2023) International Journal of Radiation Oncology, Biology, Physics

✪ Shorter Radiation Regimens and Treatment Noncompletion Among Patients With Breast and Prostate Cancer in the United States: An Analysis of Racial Disparities in Access and Quality (2023) JCO Oncology Practice

✪ A Worksheet to Facilitate Discussions of Values for Patients With Metastatic Cancer: A Pilot Study (2023) Journal of Pain and Symptom Management

✪ The Effect of Surgeon Referral and a Radiation Oncologist Productivity-Based Metric on Radiation Therapy Receipt Among Elderly Women With Early Stage Breast Cancer: Analysis From a Tertiary Cancer Network (2022) Advances in Radiation Oncology

✪ Multidisciplinary Treatment of Non-Spine Bone Metastases: Results of a Modified Delphi Consensus Process (2022) Clinical and Translational Radiation Oncology

✪ Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis (2022) Journal of the American College of Radiology

✪ Attitudes and access to resources and strategies to improve quality of radiotherapy among US radiation oncologists: A mixed methods study (2022) Journal of Medical Imaging and Radiation Oncology

✪ A Comparison of Patient- and Clinician-Reported Acute Toxic Effects During Radiation Therapy for Primary Breast Cancer (2022) International Journal of Radiation Oncology, Biology, Physics

✪ Implementation Strategies to Increase Clinical Trial Enrollment in a Community-Academic Partnership and Impact on Hispanic Representation: An Interrupted Time Series Analysis (2022) JCO Oncology Practice

✪ Association between Site-of-Care and the Cost and Modality of Radiotherapy for Prostate Cancer: Analysis of Medicare Beneficiaries from 2015 to 2017 (2021) Cancer Investigation

✪ Are 5-Year Randomized Clinical Trial Results Sufficient for Implementation of Short-Course Whole Breast Radiation Therapy?
(2021) Practical Radiation Oncology

✪ Development and Pilot Implementation of a Remote Monitoring System for Acute Toxicity Using Electronic Patient-Reported Outcomes for Patients Undergoing Radiation Therapy for Breast Cancer (2021) International Journal of Radiation Oncology, Biology, Physics

✪ Trends in Radiation Therapy for Bone Metastases, 2015 to 2017: Choosing Wisely in the Era of Complex Radiation (2021) International Journal of Radiation Oncology, Biology, Physics

✪ Clinical implementation of deep learning contour autosegmentation for prostate radiotherapy (2021) Radiotherapy and Oncology

✪ Replacing 30 Gy in 10 fractions with stereotactic body radiation therapy for bone metastases: A large multi-site single institution experience 2016-2018 (2020) Clinical and Translational Radiation Oncology