December 05, 2019
The use of intensity modulated radiation therapy (IMRT) after lumpectomy in early-stage breast cancer is associated with an average $8499 more in Medicare expenditures yet yields no expected major clinical benefit compared with conventional radiotherapy, according to a study published online in PLoS One.
“In 2013, the American Society for Radiation Oncology (ASTRO) issued a Choosing Wisely recommendation against the routine use of IMRT for whole breast irradiation,” researchers wrote. “We evaluated IMRT use and subsequent impact on Medicare expenditure in the period immediately preceding this recommendation to provide a baseline measure of IMRT use and associated cost consequences.”
The study included 13,037 women with stage I or II breast cancer who received a lumpectomy within 6 months of diagnosis and radiotherapy within the 6-month period afterward. All of the women were Medicare beneficiaries, half had left-side breast cancer, and 19.8% received IMRT.
Across the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) registries, use of IMRT ranged from 0% to 52%, according to the study. Factors associated with receiving IMRT were left-sided breast cancer, living in a big metropolitan area, living in an area with a median income of $90,000 or more, neutral or favorable local coverage determination, and free-standing treatment facility.
“Our findings clearly demonstrate the need for the 2013 Choosing Wisely recommendation,” researchers wrote, “as well how much room for improvement there is in reducing practice variation around IMRT after lumpectomy.”
Halasz LM, Patel SA, McDougall JA, et al. Intensity modulated radiation therapy following lumpectomy in early-stage breast cancer: patterns of use and cost consequences among Medicare beneficiaries [published online September 30, 2019]. PLoS One. 2019 September 30;14(9):e0222904. doi: 10.1371/journal.pone.0222904