Slow Adoption of Less Costly, Patient-Preferred Radiation Therapy

A majority of breast cancer patients in the US are receiving longer radiation therapy than is necessary and compared with their counterparts in other countries, according to a new study published in JAMA.

Researchers from the University of Pennsylvania’s Perelman School of Medicine found that two-thirds of women with early-stage breast cancer who have undergone breast conserving surgery receive 6 to 7 weeks of radiation therapy. However, 3 weeks of hypofractionated radiation is just as effective, according to multiple randomized trials and professional society guidelines. And yet, just 34.5% of women older than 50 years received the therapy in 2013, up from 10.6% in 2008, the authors wrote.

The use of hypofractionated radiation lowered total healthcare costs paid by insurers in the first year by 10%. There was no significant difference in patient out-of-pocket costs for the 2 therapies. According to the authors, this was likely because patients reach their deductible and co-payment maximums.

Not only is hypofractionated radiation high-quality, patient-centric cancer care, but it has lower costs and is more convenient for patients. Despite this, it is used infrequently for women with early-stage breast cancer, according to lead author Justin E. Bekelman, MD, an assistant professor of Radiation Oncology, Medical Ethics and Health Policy at the University of Pennsylvania’s Perelman School of Medicine and Abramson Cancer Center.

Although the therapy is a “win-win” for patients and the healthcare system, said Ezekiel J. Emanuel, MD, PhD, chairman of Penn’s Department of Medical Ethics and Health Policy and a breast oncologist, at most a third of American women are receiving hypofractionated treatment compared with at least 70% of women in other countries.

“Everything out there says we ought to be treating more women with hypofractionated therapy, and it’s only a matter of how we make that happen,” Bekelman said in a statement.

Emanuel blames the current payment structure in America for the low use of the treatment as there is no financial incentive for the shorter duration treatment. Properly aligning payment with quality is the way to reduce low-value cancer care, he said.

The treatment has been named among the top 5 Choosing Wisely initiatives for radiation oncology in 2013.