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Study Finds Hypofractionated Whole-Breast Irradiation Leads Breast Cancer Radiation Therapies in Cost-Effectiveness, Quality of Life

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Key Points

  • The researchers determined that of the three current treatment options, hypofractionated whole-breast irradiation offered the highest cost savings—about $3,000 per patient—along with better health outcomes and quality of life.
  • Single-dose treatment (intraoperative radiotherapy) may provide cost savings and patient convenience for older patients and those with transportation issues, such as women in rural areas who may not be able to travel for daily radiation therapy visits over a period of weeks.

In a study of three radiation therapies for early-stage breast cancer, one treatment option stands out as offering the most value based on factors including health outcomes, cost-effectiveness, and quality of life. The treatment—hypofractionated whole-breast irradiation—also requires fewer patient visits. The study findings were published by Deshmukh et al in the Journal of the National Cancer Institute.

Patients are increasingly interested in high-quality care at a relatively low cost, especially with rising patient co-payments and a rise in high-deductible insurance plans, said lead author Ashish A. Deshmukh, PhD, MPH, Assistant Professor in the Department of Health Services Research, Management, and Policy in the University of Florida (UF) College of Public Health and Health Professions, part of UF Health.

“We hope this study will provide important information both for patients and for providers who are making decisions about what is best for their patients,” he said. “Based on our findings, there is no reason at all to use conventional radiation therapy for early-stage breast cancer.”

Hypofractionated Whole-Breast Irradiation

After a lumpectomy is performed to remove the cancerous portion of the breast in patients with early-stage cancer, physicians typically prescribe radiation therapy to help prevent the cancer from coming back. In conventionally fractionated whole-breast irradiation therapy, patients receive daily radiation treatments over a 5- to 6-week period. With hypofractionated whole-breast irradiation, patients receive the same overall dose of radiation, but in a condensed treatment period of 3 to 4 weeks. A third and relatively new treatment, intraoperative radiotherapy, is given as a single dose of radiation at the time of the lumpectomy surgery.

Previous clinical studies have found that hypofractionated whole-breast irradiation is as effective as conventional radiation therapy in treating early-stage breast cancer, and organizations such as the National Comprehensive Cancer Network and the American Society for Radiation Oncology recommend hypofractionated whole-breast irradiation over the conventional radiation treatment. Yet, health-care providers have been slow to adopt hypofractionated whole-breast irradiation, with only about one-third of patients who are candidates for hypofractionated whole-breast irradiation receiving the treatment.

There are likely a number of reasons for this, said the study’s senior author Anna Likhacheva, MD, MPH, a staff radiation oncologist at Banner MD Anderson Cancer Center in Gilbert, Arizona, and an Adjunct Assistant Professor at The University of Texas MD Anderson Cancer Center. These include the slow diffusion of new data and guidelines to individual practitioners outside of an academic setting, and financial incentives inherent in offering a longer course of treatment through conventional therapy.

“Our current fee-for-service reimbursement structure rewards the use of conventionally fractionated treatment over hypofractionated whole-breast irradiation,” she said. “In general, patients prefer to have shorter treatment courses and would almost uniformly choose the hypofractionated approach if given the option.”

Study Findings

For the study, the researchers built a comprehensive mathematical model of early-stage breast cancer radiation therapy using health outcomes data, including cancer recurrence and mortality data from two large randomized controlled trials of hypofractionated whole-breast irradiation, intraoperative radiotherapy, and conventional radiation treatment that followed patients for 5 years. In addition, they calculated costs from the radiation treatment itself, any future treatment costs associated with recurrence, and patients’ travel costs and lost income from missing work. They also evaluated patients’ quality of life.

“Our objective was to simulate the outcomes that were closest to the real-world scenario,” Dr. Deshmukh said.

The researchers determined that of the three current treatment options, hypofractionated whole-breast irradiation offered the highest cost savings—about $3,000 per patient—along with better health outcomes and quality of life.

The team found that the single-dose treatment (intraoperative radiotherapy) may provide cost savings and patient convenience for older patients and those with transportation issues, such as women in rural areas who may not be able to travel for daily radiation therapy visits over a period of weeks.

The study did not find any evidence to support continued use of the conventional radiation treatment for patients with early-stage breast cancer.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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