Older Early-Stage Breast Cancer Patients Get More Radiation Therapy than They Need, Study Shows

Older Early-Stage Breast Cancer Patients Get More Radiation Therapy than They Need, Study Shows

More than half of older early-stage breast cancer patients received more radiation therapy than they needed, resulting in unnecessary treatments and tens of millions of dollars in extra healthcare costs.

The study with the findings, “Cost Implications of an Evidence-Based Approach to Radiation Treatment After Lumpectomy for Early-Stage Breast Cancer,” appeared in the Journal of Oncology Practice.

“It’s important to look for opportunities in cancer treatment where we can safely reduce healthcare costs without compromising excellent outcomes,” study lead author Rachel A. Greenup, MD, assistant professor of surgery at Duke Cancer Institute in Durham, N.C., said in a news release. “Our study provides an example of a win-win situation, where patients can receive high-quality, evidence-based cancer care while also reducing the treatment burden for patients and the healthcare system.”

Greenup and her colleagues used data from the National Cancer Database to identify 43,247 early-stage breast cancer patients, aged 50 years or more, who got breast cancer surgery during 2011. All the women had small breast cancer tumors that had not spread to the lymph nodes, and underwent a lumpectomy — a surgery in which doctors remove only the tumor and some surrounding tissue.

Overall, 27,697 women (64 percent of the total) received conventional radiation therapy (RT). Another 5,724 women (13.3 percent) got hypofractionated RT, a type of therapy given at higher doses but over a shorter period. Another 477 women (1.1 percent) got accelerated partial-breast irradiation, a shorter, alternative radiation technique for selected patients with favorable early-stage breast cancer. The remaining 9,349 women (21.6 percent) received no RT at all.

While evidence from other studies proves that treatment with a four-week course of breast radiation costing $8,000 is just as effective as the standard, six-week regimen, which costs over $13,000, the new study found that 57 percent of women who qualified for shorter radiation therapy regimens — or who could have foregone radiation treatment entirely — still opted for the longer, more expensive treatment.

In 2011, the total cost of RT in women older than 50 came to $420.2 million. If those women had been treated with the shorter but more intensive radiation courses, or non at all, treatment of the same cohort would have cost $256.2 million, a savings of $164 million.

Greenup said that the data available didn’t account for patients’ insurance coverage, or explain why the women opted for the longer, more expensive radiation treatments. However, she said the study’s results highlight the urgency of applying growing evidence to treatment decisions.

“Breast cancer treatment costs are projected to reach $20 billion in 2020,” said Greenup said, citing National Cancer Institute statistics. “Of course, high-quality care is the priority in cancer treatment, but our study suggests that utilization of evidence-based radiation treatment can translate into reductions in health care spending without sacrificing quality.”