INDIANAPOLIS, IN – Only one in three women with early stage breast cancer who are eligible for a shorter course of whole breast radiation therapy actually receive it, according to a study published online today in the Journal of the American Medical Association. Despite evidence that using three to four weeks of treatment is as effective as six to seven weeks in women meeting specific criteria, most received the longer duration of radiation.
The study – conducted by the University of Pennsylvania, Anthem, Inc. and its outcomes research subsidiary, HealthCore – is the first to review related practice patterns to determine whether physicians are following the latest medical evidence. While use of shorter courses of radiation – also known as hypofractionated radiation – increased over the five year study period of 2008 to 2013, only 35 percent of the appropriate candidates for the procedure received the shorter course of therapy in the last year.
“Hypofractionated radiation is infrequently used for women with early-stage breast cancer, even though it’s high-quality, patient-centric cancer care at lower cost,” said lead author Dr. Justin Bekelman, 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. “It is clinically equivalent to longer duration radiation in curing breast cancer, has similar side effects, is more convenient for patients, and allows patients to return to work or home sooner.
In addition to its clinical benefits, the use of shorter course of radiation therapy can also positively impact the health care system’s total cost of care with an average savings of $3,000 per patient, according to the study, in addition to reducing the emotional and logistical burden of longer courses of therapy.
“Recent studies have shown that equivalent tumor control and cosmetic outcome result with shorter courses of therapy of three to four weeks compared to conventional therapy of six to seven weeks,” said John Barron, HealthCore staff vice president of provider research. “It was surprising to find that despite these clinical benefits and greater convenience to patients, that the evidence was not more rapidly adopted. It doesn’t appear that physicians and patients are discussing these treatment options.”
While studies have shown that it takes an average of 17 years for research evidence to reach clinical practice, the American Society for Radiation Oncology has highlighted long courses of breast radiotherapy as one of the top five areas of inappropriate care that patients and doctors should question as part of the Choosing Wisely campaign. Given the 2011 ASTRO recommendation that women who are candidates should be offered shorter courses of
radiation therapy, the slow pace of change in practice raises questions about whether current reimbursement policies are a barrier to adoption of more patient-centered care.
“This is solid, actionable information for health plans to have because it helps in collaborating with providers to develop different approaches to payment, such as flat fee schedules or bundled payments, that can improve patient experience while potentially reducing costs and maintaining the same or better health outcomes,” said Dr. Jennifer Malin, Anthem, Inc. oncology medical director.
Co-authors of the study include Justin Bekelman, MD, Andrew J. Epstein, PhD, and Gary Freedman, MD, Ezekiel Emanuel, MD, from Penn Medicine, Jennifer Malin, MD, from Anthem, and Gosia Sylwestrzak, MS, John Barron, PharmD, and Jinan Liu, PhD from HealthCore.
About Anthem, Inc. Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With nearly 69 million people served by its affiliated companies, including more than 37 million enrolled in its family of health plans, Anthem is one of the nation’s leading health benefits companies. Anthem companies serve members as the Blue Cross licensee for California; and as the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Anthem, Inc. subsidiaries Amerigroup and CareMore also serve customers in many states across the U.S. To find out more about Anthem, go to www.antheminc.com
About HealthCore Inc. HealthCore Inc., www.healthcore.com, uses real world data, including claims information, to provide clinical and other scientific expertise and research services to the pharmaceutical, biotechnology and device industries, in the conduct of industry-sponsored safety, health economic outcomes, comparative effectiveness, epidemiological and late stage research projects. HealthCore’s capabilities include retrospective database design and analysis, prospective observational research design and analysis, safety and epidemiologic research services, post authorization safety study (PASS), health services research, patient and/or provider survey development and implementation, and general research consultation.
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