By Charles Bankhead, Staff Writer, MedPage Today
Published: November 06, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner |
|
CHICAGO — Use of brachytherapy to treat breast cancer continues to increase despite unresolved questions about long-term outcomes, according to data presented here. From 2001 through 2006, breast brachytherapy accounted for 5% of all radiation therapy administered to a cohort of more than 6,000 postmenopausal breast cancer patients. However, in the years after 2004 — when Medicare began reimbursing for the modality — use of the modality more than doubled, to 10% in the first half of 2006.The findings strongly suggest that nonclinical factors will determine breast brachytherapy’s role in coming years.“Despite ongoing debate over long-term outcomes, breast brachytherapy has been rapidly incorporated into treatment of breast cancer,” Thomas A. Buchholz, MD, of the University of Texas M. D. Anderson Cancer Center in Houston, said here at the American Society for Radiation Oncology meeting.“The availability of clinical evidence is less likely to be a major force in determining the diffusion of this new technology. Instead, nonclinical factors — such as public policy and socioeconomic factors — are likely to play an important role.”The efficacy of whole-breast irradiation after conservative surgery has been demonstrated in Phase III clinical trials involving 60,000 to 100,000 patient-years of follow-up, said Buchholz. In contrast, Phase III data of partial breast irradiation with brachytherapy has yet to mature and comprises about 1,500 patient-years of follow-up.The lack of supporting data for breast brachytherapy has created controversy regarding use of the radiation modality, he added.Access to a nationwide database of Medicare beneficiaries with private supplemental insurance provided an opportunity to examine the use of breast brachytherapy and the factors associated with its use.Buchholz and his colleagues identified 6,882 women ages 65 and older with newly diagnosed breast cancer from 2001 through 2006. The database provided access to information about inpatient, outpatient, and prescription claims.All of the patients had breast-conserving surgery followed by radiation therapy — external-beam radiation, brachytherapy, or a combination of the two modalities.Patients had a mean age of 75, 8% had axillary involvement, and 4% had metastatic disease. Buchholz said that 78% of the cohort had axillary dissection, 10% had chemotherapy, and 65% received endocrine therapy.Overall, external-beam radiation therapy accounted for 95% of all radiotherapy administered to the patients. Fewer than 1% received both external-beam radiation and brachytherapy, and the remaining patients had brachytherapy as the sole form of radiotherapy.Trend analysis showed that use of brachytherapy remained stable at about 1% of cases from 2001 to the first half of 2002, when the FDA approved the therapy. Use of brachytherapy increased to about 3% of cases in the second half of 2002 and remained at that level until the first half of 2004, when Medicare started covering brachytherapy.Brachytherapy continued to account for about 4% of all radiation therapy used to treat breast cancer through 2004, then increased to more than 6% of cases in the first half of 2005, 8% in the second half of 2005, and 10% during the first six months of 2006.Analysis of clinical factors associated with use of brachytherapy revealed three significant predictors:
- Node-negative disease (OR 2.19, 95% CI 1.17 to 4.11)
- Axillary surgery (OR 1.72, 95% CI 1.28 to 2.44)
- No chemotherapy (OR 1.68, 95% CI 1.01 to 2.80)
Examination of nonclinical factors such as geography, type of healthcare system, income, and availability of radiation oncologists and surgeons all influenced the use of brachytherapy.Using the northeast region of the U.S. as reference, Buchholz and colleagues found increased use of breast brachytherapy in western states (OR 2.83), in the South (2.36), and in the Midwest (OR 1.62).Treatment by non-HMO providers also was associated with increased use of brachytherapy (OR 1.81).A higher median income made use of brachytherapy more likely (OR 1.58), as did a low density of radiation oncologists in an area (1.78) and a high density of surgeons (OR 2.36).The authors had no disclosures. |
Comments (RSS)
