Shorter radiation regimens reduce radiation-related spending by one-third compared to extended radiation regimens for patients with breast and prostate cancers, according to a recent study (JAMA Netw Open. 2020;3(7):e2010519. doi:10.1001/jamanetworkopen.2020.10519).
“For breast and prostate cancer, shorter radiation treatment regimens lasting 3 to 5 weeks are evidence-based practices that are similarly effective and safe, and substantially less costly for payers and patients, compared with extended regimens lasting 6 to 9 weeks,” wrote Erin F. Gillespie, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, et al.
In this cross-sectional study, Dr Gillespie and colleagues aimed to examine whether a growth in the uptake of shorter radiation regimens would be greater among patients with breast cancer in comparison to those with prostate cancer.
The study included Medicare beneficiaries with breast and prostate cancer treated with external radiation. Radiation regimens were classified into 2 groups: shorter regimens (11 to 20 daily treatments for breast cancer or 11 to 30 for prostate cancer) and extended regimens (>20 or >30 daily treatments, respectively).
The study was approved as exempt for the need for informed consent by the Memorial Sloan Kettering Cancer Center institutional review board because publicly available anonymized data were used. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.
Researchers calculated compound annual growth rates and used multivariable linear regression to compare rates of change in the use of shorter regimens between breast and prostate cancer.
Additionally, spending related to shorter versus extended radiation regimens were compared from the amount reimbursed by Medicare for facility and professional serviced over the 90-day episode. This was adjusted for inflation to 2017.
Dr Gillespie and colleagues noted the statistical significance was set at 2-sided P <.025, applying a Bonferroni correction for 2 main analyses. Data analysis was performed from September to December 2019 using SAS Enterprise Guide statistical software version 9.1.
A total of 85,570 radiation episodes from 2015 to 2017 were included in the analysis for women with breast cancer aged 65 to 74 years (67%), 75 to 84 years (28%), and 85 years or older (19%). Among those with breast cancer, shorter radiation regimens increased from 33.1% (95% CI, 32.5%-33.6%) to 42.4% (95% CI, 41.9%-43.0%) (P <.001) at a compound annual growth rate of 13.2%.
Additionally, 71,720 radiation episodes were included for men with prostate cancer aged 65 to 74 years (63%), 75 to 84 years (33%), and 85 years or older (4%). Among those with prostate cancer, shorter regimens increased from 13.4% (95% CI, 13.0%-13.9%) to 16.7% (95% CI, 16.2%-17.2%) (P <.001) at a compound annual growth rate of 11.6%.
These results how that the rates of change in use of shorter regimens did not differ significantly between breast cancer and prostate cancer (compound annual growth rate, 13.2% vs 11.6%).
In the analysis for radiation-related spending, the mean 90-day spending was 33% lower for beneficiaries with breast cancer treated with shorter compared with extended regimens ($9204 [95% CI, $9179-$9229] vs $13,733 [95% CI, $13,707-$13,759]; difference = $4529; P <.001) and 34% lower for prostate cancer ($18,709 [95% CI, $18,580-$18,839] vs $28,262 [95% CI, $28,217-$28,307]; difference = $9553; P <.001)
“Among Medicare beneficiaries receiving radiation treatment between 2015 and 2017, the rate of uptake of shorter radiation regimens was modest and did not differ meaningfully between breast and prostate cancer,” explained Dr Gillespie and colleagues.
“We also found that shorter radiation regimens for prostate cancer, like breast cancer, reduce radiation-related spending by approximately one-third,” they concluded.—Janelle Bradley
