A key benefit of the NSW Health value-based approach to program design is its patient-centric nature. Supporting the health system to deliver person-centred, value-based cancer care is a priority of the Cancer Institute NSW.
Over the last three years, the Cancer Institute NSW has been leading the implementation of the Breast Cancer Hypofractionation Initiative, a tranche two initiative of the Leading Better Value Care program.
Over the course of this initiative, we’re pleased to report an increase in the use of hypofractionated radiation therapy for women with early-stage breast cancer following breast-conserving surgery. The proportion of women with early-stage breast cancer who received hypofractionated radiation therapy increased from 75% in 2017 to 90% in 2020 in NSW public facilities, and from 52% in 2017 to 83% in 2020 in NSW private facilities.
Since 2011, evidence-based guidelines have recommended the use of hypofractionated radiation therapy as a suitable alternative to non-hypofractionated radiation therapy for women with early-stage breast cancer. The Institute first reported the use of hypofractionated radiation therapy for the treatment of early-stage breast cancer in 2016 as part of our Reporting for Better Cancer Outcomes (RBCO) program. RBCO reports highlighted significant variation in the use of hypofractionation across public and private facilities in NSW.
Hypofractionated radiation therapy has been used for women with early-stage breast cancer in NSW, but with variation in the levels of uptake. The Leading Better Value Care model helped accelerate our efforts to increase uptake and reduce variation in hypofractionation rates across health facilities in NSW.
Increased use of hypofractionated radiation therapy benefits the woman receiving treatment by reducing the number of treatment episodes. Women can enjoy less time at treatment, spend less time travelling to treatment, and potentially achieve better cosmetic results. It also has system benefits, as increased use of hypofractionated radiation therapy can increase the number of women treated with existing resources and therefore reduce pressure on the system.
We couldn’t have achieved these results without the leadership of clinicians working in radiation therapy treatment centres. Thank you. Your involvement helped us understand the key barriers and enablers to local uptake of hypofractionation and develop relevant resources, which are widely used across the state.
The Cancer Institute NSW will continue to deliver insights on hypofractionation rates through RBCO and Leading Better Value Care reporting. Our work exploring clinical variation across the NSW cancer system is underpinned by the principles of value-based care.