(RxWiki News) Not all breast cancer treatment methods are created equal — and many patients may not always get the shortest, most cost-effective option.
Women with early-stage breast cancer who have breast-conserving surgery may receive shorter, less costly radiation treatment. Most who qualify for this treatment, however, may not be getting it, a new study found.
The use of this shorter-term treatment has grown, but a large number of women who could be getting it were not, this study found.
“Hypofractionated whole-breast irradiation increases convenience, reduces treatment burden, and lowers health care costs while offering similar cancer control and [cosmetic outcomes] to conventional whole-breast irradiation,” wrote the study authors, led by Justin E. Bekelman, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia. “Furthermore, patients prefer shorter radiation treatment regimens.”
Breast conservation surgery is a common treatment for early-stage breast cancer. Also called breast-sparing surgery, it removes the cancer but not the breast itself. Radiation therapy is typically given following surgery to help lower the chance that the cancer will come back in the breast or nearby lymph nodes.
Conventional radiation treatment (whole-breast irradiation) can involve daily radiation treatments for five to seven weeks. Radiation using fewer treatments but given in larger doses — called hypofractionated whole-breast irradiation — has been shown to be just as effective. It can be given in three to five weeks.
In 2011, the American Society for Radiation Oncology (ASRO) said that hypofractionated whole-breast irradiation was equally effective for in-breast tumor control and comparable in long-term side effects for many women with early-stage breast cancer. The ASRO has endorsed this treatment for patients 50 years old or older without prior chemotherapy (medications used to destroy cancer cells) or cancer of the lymph nodes in the underarm.
In this study, a total of 8,924 patients were categorized as being hypofractionation-endorsed, according to the ASRO's guidelines. And 6,719 were hypofractionation-permitted. The patients who were "permitted" did not meet the ASRO's standards for endorsement — meaning they might have been younger than 50 or had cancer in the lymph nodes — but were still allowed to have the treatment.
Dr. Bekelman and team reviewed the usage and costs of hypofractionated whole-breast irradiation between 2008 and 2013. They referenced claims from 14 commercial health care plans. In total, these plans covered 7.4 percent of US adult women in 2013.
The women studied had early-stage breast cancer treated with lumpectomy. Lumpectomy is the removal of the breast cancer tumor, or the "lump.” This common type of breast conservation surgery also removes some of the normal tissue surrounding the cancer.
Among women in the hypofractionation-endorsed group, hypofractionated whole-breast irradiation increased from over 10 percent in 2008 to over 34 percent in 2013.
In the hypofractionation-permitted group, this shorter-term type of treatment rose from 8 percent in 2008 to 21 percent in 2013.
Although more women were getting hypofractionated whole-breast irradiation in 2013, the great majority of those who might be receiving this therapy were not getting it, Dr. Bekelman and colleagues said.
“The [ASRO] guidelines stopped short of recommending hypofractionated whole-breast irradiation as a care standard to be used in place of conventional whole-breast irradiation,” Dr. Bekelman and team wrote. “The absence of a clear recommendation may have contributed to slower uptake of hypofractionation in the United States than in other countries.”
In both groups, health care costs were higher for those who received conventional whole-breast irradiation. In the hypofractionation-endorsed patients, mean health care expenditures at one year after diagnosis were $28,747 for hypofractionated — versus $31,641 for conventional whole-breast irradiation. In the hypofractionation-permitted group, those costs were $64,273 for hypofractionated and $72,860 for conventional whole-breast irradiation.
This study was published Dec. 10 in JAMA to coincide with the San Antonio Breast Cancer Symposium. Dr. Bekelman received support from a grant from the National Cancer Institute.