December 12, 2014 — Only about one-third of early-stage breast cancer patients receive a recommended shorter course of radiation following surgery, despite evidence that it works as well as longer courses, according to a study published Wednesday in the Journal of the American Medical Association, Reuters reports.
The American Society for Radiation Oncology in 2011 recommended that certain women ages 50 and older receive a three-week, high-dose course of radiation after a lumpectomy.
Previously, the standard treatment for many early breast cancers after a lumpectomy was five to seven weeks of radiation at a lower dose. The shorter course "has been found to be effective and no more toxic" than the longer course, study lead author Justin Bekelman of the University of Pennsylvania's Perelman School of Medicine explained.
The 2011 guidelines also suggested that the shorter course could be effective in some younger women, but they did not recommend the three-week course as the standard of care for such patients.
To gauge the number of women who received treatment in accordance with the 2011 recommendations, the researchers analyzed claims data from private insurers that covered early-stage breast cancer radiation courses from 2008 to 2013. The claims included 9.2 million women, accounting for 7.4% of U.S. women. The researchers also set out to determine whether the shorter treatment courses are affecting health care costs (Rapaport, Reuters, 12/10).
Researchers from the Perelman School of Medicine conducted the study with Anthem and Anthem subsidiary HealthCore (Szabo, USA Today, 12/10).
The study found that 34.5% of older women who were eligible for the shorter treatment course received it in 2013, up from 10.6% in 2008. Among younger women, the share of those who received the shorter course increased from 8.1% in 2008 to 21.2% in 2013 (Reuters, 12/10).
Further, the study found that care was less costly for women who received the shorter treatment course. Specifically, older women who received the shorter course had average health care costs of about $28,747 in the year following their diagnoses, which was about 9% lower than if they had received the longer treatment (USA Today, 12/10). Costs for younger women who received the shorter treatments were about 11.8% lower than those receiving the long course, on average, according to the study.
However, the study authors noted that using claims data for the study meant they could not distinguish which types of tumors the women had or the doses of radiation they received. In addition, the researchers could have underestimated care costs because some of the claims data might not have been processed by the end of 2013.
According to the study authors, one reason many patients are still getting the extended course is that the 2011 guidelines stopped short of endorsing the shorter course for younger women (Reuters, 12/10).
In addition, study co-author Ezekiel Emanuel, chair of the University of Pennsylvania's Department of Medical Ethics and Health Policy, noted that physicians in charge of radiation treatments would bring in less money if more women received the shorter course. He said the shorter course is preferable overall because women "get done with radiation four weeks early, and for society it's less expensive," adding, "I think patients and breast cancer advocates need to take a stand on this" (Shute, "Shots," NPR, 12/10).
However, Sheryl Green, an assistant professor of radiation oncology at the Icahn School of Medicine at Mount Sinai, said there are still unanswered questions about whether the shorter course is safe and effective for certain patients, adding that more research is needed on combining a short course with drugs and other treatments (USA Today, 12/10).