In 2011, expert guidelines endorsed shorter whole breast radiation for early-stage breast cancer patients. However, a new study finds that this less costly treatment has not reached many patients who meet guidelines to receive it.
The study - led by Dr. Justin E. Bekelman, of the University of Pennsylvania Perelman School of Medicine in Philadelphia - is published in JAMA and is released to coincide with the San Antonio Breast Cancer Symposium.
The researchers explain that breast conservation therapy is the most common treatment for early-stage breast cancer, with whole breast irradiation (WBI) recommended for most women after surgery, as it reduces recurrence and improves overall survival.
Conventional WBI has been the "mainstay" of treatment in the US and consists of 5-7 weeks of daily radiation treatments. However, hypofractionated WBI is a shorter alternative to conventional WBI, consisting of fewer higher-dose treatments over 3 weeks.
"Hypofractionated WBI increases convenience, reduces treatment burden and lowers health care costs," note the authors, "while offering similar cancer control and cosmesis (cosmetic outcomes) to conventional WBI." They also note that patients naturally prefer shorter radiation treatments.
Following high-quality clinical trials, experts endorsed the shorter treatment for patients with early-stage breast cancer. In their latest study, the team wanted to assess the uptake and costs of the shorter treatment among commercially insured patients in the US.
'Evaluation of future treatment patterns important for tracking treatment adoption'
To do so, the researchers looked at the usage and costs of hypofractionated WBI from 2008-2013, which was before and after the publication of key clinical trials and revised practice guidelines.
In total, the data contained information from 14 commercial health care plans, which covered 7.4% of US adult women in 2013. It also classified patients with incident early-stage breast cancer treated with lumpectomy and WBI from 2008-2013 into two groups:
- Hypofractionation-endorsed group: 8,924 women who were endorsed for hypofractionated WBI, who were over the age of 50 without prior chemotherapy or axillary lymph node involvement
- Hypofractionation-permitted group: 6,719 women who were permitted to have hypofractionated WBI, who were younger than 50 years or who had prior chemotherapy or axillary lymph node involvement.
Hypofractionated WBI consisted of 3-5 weeks of treatment, while conventional WBI lasted 5-7 weeks in this analysis.
Results showed that although hypofractionated WBI increased among women with early-stage breast cancer from 2008-2013, only 34.5% of patients from the hypofractionation-endorsed group and 21.2% from the hypofractionation-permitted group received the shorter, cheaper treatment in 2013.
The researchers note that adjusted average total health care expenditures during the year after diagnosis were $28,747 for the shorter treatment and $31,641 for the longer treatment in the endorsed group and $64,273 for the shorter treatment and $72,860 for the longer treatment in the permitted group.
Breast cancer comprises the largest portion of national expenditures on cancer care and is estimated to reach $158 billion in 2020, so cost-saving measures are undoubtedly of great importance in this area.
The study authors say that despite the updated 2011 practice guidelines, they "stopped short of recommending hypofractionated WBI as a care standard to be used in place of conventional WBI." They add:
"The absence of a clear recommendation may have contributed to slower uptake of hypofractionation in the US than in other countries. In 2013, we observed more pronounced uptake of hypofractionation; evaluation of future treatment patterns will be important to document whether or not this trend reflects the beginning of more widespread adoption."
Earlier this week, Medical News Today reported on a study that suggested almost two thirds of elderly female patients with early-stage breast cancer received radiation treatment, despite clinical trials supporting the omission of such treatment.