By Lisa Rapaport
(Reuters Health) - Many early-stage breast cancer patients don’t get the recommended short course of radiation after surgery, even though it’s considered just as good as prolonged treatment, a new study finds.
“Only a third of women are getting a shorter course of radiation that has been found to be effective and no more toxic," said lead author Dr. Justin Bekelman, of the University of Pennsylvania Perelman School of Medicine in Philadelphia.
"In cancer care, physicians and patients often believe that more is better. This is a treatment that shows more is not always better and sometimes less is right," Bekelman told Reuters Health.
The standard treatment for many types of early-stage breast cancer has for years been lumpectomy, a surgery to remove malignant tissue while sparing the rest of the breast, followed by about five to seven weeks of radiation.
In 2011, the American Society for Radiation Oncology recommended a shorter, three-week cycle of radiation at higher doses for some women age 50 and older. The new guidelines also suggested this might work for certain younger women, but stopped short of advocating the three-week course as the new standard of care for them, Bekelman and colleagues write in the Journal of the American Medical Association.
In part because the new recommendations didn't propose adopting the shorter course for all women, the majority of patients still receive extended treatment, the study team writes.
To see how many women are getting treatment according to the new guidelines, and whether it is affecting healthcare costs, the researchers examined claims data from private health plans covering early-stage breast cancer radiation treatments from 2008 through 2013. The database included 9.2 million women, or 7.4 percent of U.S. women.
Among older women who ought to be getting the shorter radiation treatment, 34.5 percent of them did get it in 2013, up from just 10.6 percent in 2008. For younger women, use of the abbreviated treatment increased to 21.2 percent from 8.1 percent.
Care cost less for the women given shorter treatments, the study found. For older women, the average cost of care in the year after diagnosis was $28,747, which is 9.1 percent less than the typical outlay if they had received prolonged therapy. For younger women, the average savings was 11.8 percent with the shorter radiation treatment.
The study authors caution that using claims data rather than medical records meant they could not verify the women’s tumor types and radiation doses. It also meant they may have underestimated costs because some claims for the last year of the study might not have been processed by the end of 2013.
About one in eight U.S. women will develop invasive breast cancer in her lifetime. And annual treatment costs for these malignancies is estimated to exceed $20 billion by 2020, according to the National Cancer Institute.
Despite the potential for shorter radiation cycles to curb costs, some doctors may stick to the older protocol because they make more money billing for the extended course of treatment, said Dr. Benjamin Smith, associate professor of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston.
Smith, the lead author of the 2011 recommendations in favor of the shorter treatment, said he provides it to most of his patients. “This change in our recipe is just as safe and just as effective as the way we had been doing things before, and if anything, it may be a little bit safer,” told Reuters Health.
But many physicians have a hard time accepting the idea that a higher dose could be safe, particularly because the impacts of treatment – both the protection from cancer and the potential harmful side effects – can last for years, Smith said.
He added that he was surprised to see the new study found as many women getting the shorter treatment course as it did. “The dogma is that if you give a high dose per day you are going to hurt your patient over the long term, and that has seeped into the culture of radiation oncology like the ten commandments or the pledge of allegiance,” Smith said.
SOURCE: http://bit.ly/1wyiHxK Journal of the American Medical Association, online December 10, 2014.