No RT at all
The study authors then determined national RT patterns and estimated RT costs using the Medicare Physician Fee Schedule.

Key Findings
Since 2002, numerous studies have been published suggesting that hypofractionated RT regimens with fewer treatments and higher doses of radiation were a safe alternative in carefully selected patients. In 2013, the American Society of Radiation Oncology through the Choosing Wisely campaign recommended considering shorter RT regimens among women with breast cancer who are 50 years and older. Guided by that evidence base, the study authors found:
Within the 43,247 patient cohort, 64% received conventional RT, 14.4% received accelerated or hypofractionated RT and 21.6% received no RT.
The estimated costs for all RT treatments for all 43,247 patients in 2011 were approximately $420.2 million.
Of the patients who were eligible for shorter RT or no RT, 57% underwent treatment with longer, costlier regimens.
Had these patients received the other RT therapies for which they were safely eligible, the overall estimated treatment costs in 2011 would have been $256.2 million.
This shows a potential savings of $164 million or 39% reduction in cost of care for patients.
This analysis is the largest study to date to examine a strategic radiation approach and the potential implications on cost savings.

Next Steps
The authors reported that the study was limited by the fact that the NCDB may not fully capture the experience of patients who elect to receive RT in a different practice than where they received the lumpectomy. In addition, clinical decisions made by patients and physicians are often based on factors that are not fully captured in a large database.

Dr. Greenup also noted that the findings emphasize that that there are “win-win” scenarios in cancer treatment.

“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,” said Dr. Greenup. “When patients can receive excellent cancer care that reduces the treatment burden and translates into decreased health care costs, that’s high-quality, high-value care.”

The researchers state that patient preference is best maintained when all treatment options are discussed. Dr. Greenup is currently evaluating how costs of cancer care might become part of the shared decision-making process between patients and physicians as women choose treatment for breast cancer.

The study received funding support from the NIH Building Interdisciplinary Research in Women’s Health award.

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