Alternative facts.

It is little wonder that patients are so hesitant to sign up for radiation with articles like this week’s NPR op-ed on the evils of conventional fractionation for breast cancer. We talk a lot about hypofractionation across different sites, highlighting the obvious perk of a shorter treatment course (which patients love). But what is not apparent to those outside radiation oncology—and certainly not to the author or subjects of this opinion piece—is that shorter radiation does not equal less radiation; the regimen they’re looking for is called partial breast. While convenience and costs are both big benefits with shorter courses, we (responsibly) await mature data on the safety of its use on higher risk populations such as those requiring large fields or recent cytotoxic chemotherapy. We know you know your reasoning for choosing conventional over hypofractionation, but your patients probably don’t. So we suggest you explain it to them before they get a hold of alternative explanations of alternative regimens...or risk being the subject of the next eviCore-sponsored editorial.