Breast Cancer Radiation Therapy For 6 Or 7 Weeks May Be Too Long For Some Patients
There may not be enough financial incentive to give early-stage breast cancer patients shorter-term radiation therapy, according to a new JAMA study.
Let’s take a step back: Researchers from the University of Pennsylvania Health System found two-thirds of women treated for breast cancer in the United States receive conventional whole breast radiation, which lasts six to seven weeks. This is despite the “multiple randomized trials and professional society guidelines showing three weeks of hypofractionated whole breast radiation” is equally effective. Not only that, but it’s more convenient and lowers total health care costs paid by insurers up to 10 percent the first year following a diagnosis.
"Hypofractionated radiation is high-value care and high-quality breast cancer treatment that saves the health care system money. It's a win-win. And yet, only a third or fewer women are getting it in the U.S.," Dr. Ezekiel J. Emanuel, senior study author and chairman of UPenn's Department of Medical Ethics and Health Policy, said in a press release.
Why aren’t more women receiving this type of radiation? Emanuel said the biggest hurdle is there is no financial incentive to recommend shorter duration treatment. “We need to properly align payment with health care quality in order to reduce low-value cancer care,” he said.
In which case, it’s less surprising to consider women outside of the U.S. often opt for this type of treatment. Emanuel and his team found more than 70 percent of women in Canada received hypofractionated therapy versus conventional in 2008, with an even greater percent of women receiving the treatment in the UK.
The total dose of the hypofractionated radiation treatment is divided into large doses and administered once a day. Though it involves higher doses, the American Society for Radiation Oncology gave it a stamp of approval in their 2011 practice guidelines. The less time spent in treatment, the quicker breast cancer patients can get back home and to work. (Be sure to discuss this alternative radiation with their physician first.)
Dr. Jennifer Malin, oncology medical director for health benefits company Anthem Inc., agrees.
"This is solid, actionable information for health plans to have because it helps in collaborating with providers to develop different approaches to payment, such as flat fee schedules or bundled payments, that can improve patient experience while potentially reducing costs and maintaining the same or better health outcomes," she said.
Source: Bekelman E, et al. Uptake and Costs of Hypofractionated vs Conventional Whole Breast Irradiation After Breast Conserving Surgery in the United States, 2008–2013. The Journal of the American Medical Association. 2014.