Study: Cost savings associated with a shorter course or omission of radiation treatment for early-stage breast cancer
|At a glance
|Questions for your doctor
This study is about:
Potential health care cost savings if breast cancer patients received the least expensive radiation regimen for which they were safely eligible.
Why is this study important?
According to the study authors, “Breast cancer treatment costs are the highest among all cancer types, estimated to reach $20 billion by 2020.” While patients and their healthcare providers should work together to determine the most effective treatment plan, high-quality cost-effective treatments are increasingly needed.
For patients with breast cancer, who do not carry a , , , or other genetic mutation associated with increased breast cancer risk, is often the preferred surgical treatment option. is often followed by radiation therapy (RT), a type of cancer treatment that uses beams of energy to kill cancer cells. Whole breast irradiation (WBI) is recommended for most women after as it has been shown to reduce local recurrence and improve overall survival. Currently there are two standard-of-care radiation therapy regimens following .
- Conventional Whole Breast Irradiation (C-WBI), consists of 5 to 7 weeks of daily radiation treatments.
- Hypofractionated WBI (HF-WBI) involves delivering a higher dose of radiation over a shorter period of time of about 3 weeks.
HF-WBI is considered less costly than C-WBI. As recently as 2014, patients were commonly treated with the conventional 5-7 week radiation therapy. However, several trials have confirmed that patients treated with the shorter, HF-WBI have similar disease-free and overall survival rates as those treated with CF-WBI. The American Society for Radiation Oncology (ASTRO) and other professional groups have issued guidelines for use of HF-WBI in patients: women with small (≤3 cm), node-negative breast cancers with negative surgical margins, patients who are at least 50 years old, and patients who have non-invasive disease.
- About 57% of breast cancer patients in 2011 were safely eligible for a shorter radiation treatment or no radiation treatment compared to the radiation treatment that they received.
- The study authors estimated that if these breast cancer patients had received the least expensive radiation treatment for which they were safely eligible, estimated savings would have been almost $170 million.
What does this mean for me?
This study received a "Medium" relevance score because the results do not necessarily impact the medical decisions of women diagnosed with breast cancer today.
The research presented suggests that costs for radiation therapy to treat breast cancer in 2011 would have been significantly less if patients would have received the least expensive radiation regimen for which they were safely eligible. The authors concluded that, “A majority of women in the United States are receiving longer and more costly radiation treatment than current data deem medically necessary.”
While this study is interesting, even the authors noted that treatment decisions are complex and based on many factors that were not considered in this study. It is possible that the women who looked like they were eligible for less radiation on paper actually needed a higher dose based on their specific anatomy or other factors found on physical exam. Finally, this study looked at patient data from 2011. When considering RT patients should discuss with their health care provider current recommendations. Careful consideration of a radiation treatment regimen must be made by a patient and her care team.
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Greenup RA, Blitzblau RC, Houck KL, et al. “Cost implications of an evidence-based approach to radiation treatment after for breast cancer.” Journal of Oncology Practice. Published online first on March 14, 2017.
Kyung Su Kim, MD, Kyung Hwan Shin, MD, PhD, Noorie Choi, MD, and Sea-Won Lee, MD., "Hypofractionated whole breast irradiation: new standard in early breast cancer after breast-conserving surgery." Radiat Oncol J. 2016 Jun; 34(2): 81–87.
FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.
This article is relevant for:
This article is also relevant for:
people with triple negative breast cancer
people with ER/PR + cancer
people with Her2-positive cancer
people with a genetic mutation linked to cancer risk
people with breast cancer
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IN-DEPTH REVIEW OF RESEARCH
Previous work suggested that radiation regimens with fewer treatments and higher radiation amounts were safe. Patients who received whole-breast irradiation consisting of 42.5 Gy (Gray or Gy is a measure of the dose of irradiation or the amount of energy being transferred) in 16 treatments over 22 days had similar survival rates compared to patients who received traditional whole breast irradiation consisting of 50 Gy in 25 treatments over 35 days. Additionally, some clinical trial data suggests that some carefully selected patients may avoid radiation treatment entirely after .
As recently as 2014 patients were commonly treated with the conventional 5-7 week radiation therapy. The American Society for Radiation Oncology (ASTRO) and other professional groups have issued guidelines for use of HF-WBI in patients: women with small (≤3 cm), node-negative breast cancers with negative surgical margins, patients who are at least 50 years old, and patients who have non-invasive disease.
The choice of radiation treatment, as well as identification of patients who can be managed without radiation, can impact health care spending. Rachel Greenup and colleagues from Duke University Medical Center and other institutions published work in the Journal of Oncology Practice to estimate cost savings if breast cancer patients received the least costly radiation treatment for which they were safely eligible based on the criteria in this study. It is important to remember that for individual patients, the criteria is complex and must be made between the patient and her care team. Furthermore, recurrence rates with different types of radiation therapy should be carefully considered.
Researchers of this study wanted to know:
What are the potential health care cost savings if breast cancer patients received the least expensive radiation regimen for which they were safely eligible?
Population(s) looked at in the study:
This study analyzed data from the American College of Surgeons National Cancer Database (NCDB). Women who had node-negative, invasive breast cancers and were treated with during 2011 were the study group because of the availability of cost data. Cost data for the following radiation treatment regimens was collected:
- and conventionally fractionated whole-breast external-beam irradiation (CF-WBI) or traditional RT (27,697 women; 64%)
- Estimated radiation cost $13,358
- and hypofractionated whole-breast irradiation (HF-WBI) (5724 women; 13%)
- Estimated radiation cost $8,328
- without radiation treatment (9,349 women; 21.6%)
- Estimated radiation cost $0
- About 57% of breast cancer patients in 2011 were safely eligible for a shorter radiation treatment or no radiation treatment compared to the treatment that they received.
- The study authors concluded that if these patients had received the least expensive radiation regimens that they were safely eligible for, estimated costs would have been $252.2 million compared to the $420.2 million that was spent in 2011 for a cost savings of almost $170 million.
- One of the biggest limitations of this study is that it generalizes breast cancer patient care without considering specific individual issues. Regardless of the results of this study, the final treatment decision should be made by a patient and her health care providers.
- This study used data from 2011 and radiation treatment regimens have changed. It is likely that today more patients are being offered a shorter course of radiation for treatment of early breast cancer.
- In addition, this was a study, meaning the authors used data from previously documented records of past patients instead of collecting patient data specifically for this study. This means that other factors that were unknown to the study authors may have affected the results.
- Additionally, the authors were unable to estimate the costs of breast cancer recurrence when comparing the different radiation treatment regimens because the database they used did not include recurrence rates or data on treatment after recurrence.
- Finally, the study authors stated that “It is important to acknowledge the risk of perceived overtreatment within this study when women may have in fact received appropriate care. Clinical decisions made by the treating team are often based on patient factors and features of the disease that are not captured within large national databases…”
This study suggests that health care costs associated with radiation treatment could be reduced if patients received the least expensive radiation regimen for which they were safely eligible. However, this study does not capture all the factors that go into a treatment decision. Individuals who are genetically predisposed to breast cancer should know that recurrence rates are higher for mutation carriers who undergo and radiation therapy. Women should continue to work with their health care providers to determine the treatment that is best for them.
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Who covered this study?
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