In 2013, 230,815 women and 2,109 men were diagnosed with breast cancer in the United States and 40,860 women and 464 men died from the disease.
By 2020, annual breast cancer treatment costs are projected to reach $20 billion.
The primary focus of breast cancer care is providing these patients with the best, most effective treatment, said Dr. Rachel A. Greenup, MPH, assistant professor of surgery at the Duke University School Medicine.
However, there is a real need to reduce costs where possible, Greenup adds, as long as care is not compromised.
Greenup is the lead author of a study published today in the Journal of Oncology Practice.
Saving money in breast cancer care
To investigate whether cost savings could be made in the treatment of breast cancer, Greenup and her team from the Duke Cancer Institute in North Carolina, used data from the National Cancer Database taken in 2011.
In total, the analysis looked at 43,000 breast cancer patients aged 50 or older.
All patients had small tumors that had not spread to the lymph nodes and had undergone a lumpectomy (surgical removal of the cancer without removing the breast).
Earlier research has shown that this type of patient can do equally well when given a 4-week course of radiation, compared with the standard 6-week course.
Another previous study demonstrated that some patients aged 70 or over, who were receiving tamoxifen (a breast cancer drug), did not show any increased survival benefits when also treated with radiation therapy.
In other words, certain breast cancer patients have been shown to do equally well on a reduced course of radiation therapy or no radiation therapy at all.
Despite this knowledge, the current study showed that 57 percent of the patients that could have safely reduced (or removed) radiation therapy were still given the full, longer regimens.
“Our study provides an example of a win-win situation, where patients can receive high-quality, evidence-based cancer care while also reducing the treatment burden for patients and the healthcare system,” Greenup said in a press statement.
Using Medicare reimbursement data, the researchers estimated that the cost of the lengthier radiation therapy was more than $13,000 per person, compared with around $8,000 for the shorter radiation regimen. Without any radiation treatment, the cost is zero.
Millions of dollars could be saved
Scaling up the data, the researchers delved into Medicare data for all women with breast cancer over the age of 50 and who were eligible to receive a reduced radiation course.
They concluded that the overall cost of treatment in the U.S. was around $420 million in 2011. If these women had been treated using the alternative approaches that are backed by research, the cost could have been lowered to $256 million, a saving of $164 million.
“Of course, high-quality care is the priority in cancer treatment, but our study suggests that utilization of evidence-based radiation treatment can translate into reductions in healthcare spending without sacrificing quality,” Greenup said.
Aside from the reduction in cost, a shorter radiation course would be better for patients, the researchers concluded.
The women being treated would not be required to make as many hospital visits, and potentially lose out on work and family time, but they would still receive the best possible care.
The study is guaranteed to spark debate. There are, however, shortfalls in the research, as the authors make clear.
For instance, Medicare data were used to assess costs, but insurance data would have been more accurate. Those figures were not available to the researchers.
Also, the data did not explain why each individual patient subscribed to the longer treatment plan. The 6-week course may have been warranted for reasons not explained in the dataset. Alternatively, the patient may not have felt confident deciding to reduce or omit radiation therapy, making it a personal rather than clinical decision.
Despite these shortfalls, the research highlights an area where substantial savings could be made without jeopardizing levels of patient care, Greenup said.
“It's important to look for opportunities in cancer treatment where we can safely reduce healthcare costs without compromising excellent outcomes,” she said.