ASCO Perspective
Don S. Dizon, MD, ASCO Expert in Breast Cancer
“There are many factors in determining high-quality, high-value care for our patients, including clinical benefit and costs. This study suggests that the tailored use of radiation therapy (including when not to use it) based on clinical evidence represent high quality cancer care, particularly in women 50 years and older who undergo lumpectomy. At the same time, this study demonstrates that this evidence-based approach to treatment also reduces the associated costs. This study further emphasizes the importance of the shared decision-making process between physicians and patients.”
A new study demonstrates that the use of less radiation therapy (RT) for breast cancer patients who have undergone lumpectomy does not negatively impact patient outcomes, and could result in significant reductions in health care costs. These findings, which examine patient eligibility for evidence-based radiation therapies or no RT in the National Cancer Database (NCDB), were published online today in the Journal of Oncology Practice. People living with breast cancer often receive lumpectomy followed by RT instead of a full mastectomy because research has demonstrated that there is no difference in disease-specific or overall survival.
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“This study is an important reminder that there are treatment strategies that can retain high quality cancer care, while reducing health care costs,” said study author Rachel Greenup MD, MPH, Director of Breast Fellowship and Assistant Professor of Surgery at Duke University School of Medicine. “There are opportunities in cancer care to align high value care, patient preferences and societal benefits of reduced health care spending.”
About the Study
Researchers accessed the NCDB, a database of clinical and demographic data from tumor registries capturing approximately 70% of all newly diagnosed cancers in the U.S., to identify more than 43,000 women with invasive breast cancers who had received a lumpectomy in 2011. Through analysis, the patients were determined to be candidates for two types of RT or no RT:
Conventional fractionated whole-breast irradiation (a 5-6 week therapy where RT is applied to the whole breast for the first 4-5 weeks and then followed by more focused treatment on the tumor)
Shorter course whole-breast irradiation (accelerated or hypofractionated courses delivered in a 3-4 week therapy by using a higher daily dose of RT to the breast)
