Sometimes Less Is More . . . at Least When It comes to Radiation Therapy for Breast Cancer
Early-stage breast cancer patients often need radiation therapy as part of their treatment. Evidence on how long the radiation treatment should last has been evolving. For some patients, short-course radiation given over three to five weeks is a cost-effective option with clinical outcomes that are comparable to extended radiation. In fact, the American Society of Radiation Oncology also lists the frequency of breast radiotherapy as one of the top ten radiology measures patients and their doctors should question as part of the Choosing Wisely campaign.
Previous research conducted by HealthCore and the University of Pennsylvania, published in the Journal of the American Medical Association, showed that oncologists were slow to respond to new evidence and guideline changes that occurred in 2011. In 2013, only one in three women with early stage breast cancer who were eligible for a shorter course of breast radiation therapy, or hypofractionated treatment, actually received it. Most women received the longer duration of radiation despite evidence that using three to four weeks of treatment is as effective as six to seven weeks in women meeting specific criteria.
However, when we analyzed data from an insurer that adopted evidence-based clinical guidelines for the use of radiation therapy in treating consumers with breast cancer, we found that its network radiologists were faster to adopt these guidelines.
Our analysis, presented at the American Society of Clinical Oncology meeting in June of 2018, compared patients who were subject to new clinical guidelines and other patients who were not. We saw less overtreatment, which not only reduces costs to the healthcare system, but also reduces side effects by advocating for shorter regimens that have been shown to be less toxic and produce fewer side effects, such as redness, burning, itching and pain. Specifically, the data showed that use of shorter regimens increased by 29 percent in the patients who were subject to new clinical guidelines, compared to only nine percent among those patients with plans that did not choose to implement the guideline change.
While it was encouraging to see increase in guideline-recommended care across the board, our results highlight that payor policies can significantly accelerate adoption of evidence-driven care above and beyond what physicians are doing on their own.