1. DiGiulio, Sarah

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Several studies have investigated how outcomes and costs compare when it comes to choosing intraoperative radiation therapy versus external beam radiation therapy (EBRT). There are pros and cons to each treatment approach and, for some women, one or the other may be medically necessary.

Rakesh Patel, MD. Ra... - Click to enlarge in new windowRakesh Patel, MD. Rakesh Patel, MD

But data that has been missing includes a comparison of the financial costs and the quality-of-life benefits and costs for each therapy over women's full lifetime.


A group of researchers recently collected such data and found that intraoperative radiation therapy did have lower lifetime costs compared with EBRT, as well as improved quality of life for the women receiving the treatment, according to a new study published online in Cost Effectiveness and Resource Allocation (2017; doi:10.1186/s12962-017-0084-5).


"Our analysis demonstrated that intraoperative radiation therapy could result in a direct cost savings for the U.S. health care system of more than $630 million over the lifetime of patients diagnosed annually with early-stage breast cancer, as well as significantly benefit patient health by minimizing radiation exposure and offering a better quality of life," the study's lead author Rakesh Patel, MD, Radiation Oncologists at Good Samaritan Hospital in Los Gatos, Calif., shared with Oncology Times.


The researchers used a Markov decision-analytic model using data obtained from peer-reviewed literature to compare the use of the two types of radiation therapy in women with early-stage (stages I-IIA/IIB) breast cancer. (That means that estimates of adverse events, quality of life, and incidence of death were based on probabilities extrapolated from the best available data in the literature to predict long-term outcomes for women receiving each type of treatment.) For EBRT, the researchers looked at data from 6-week treatment courses.


Here's why Patel said this data is significant.


1 This topic and the question you looked at is not necessarily one that's been ignored in other literature and research. Why was this study important and why now?

"This study examined the quality of life and direct costs of care in treating early-stage breast cancer with intraoperative radiation therapy versus EBRT over the life of the patient.


"In today's value-based health care landscape, it is important for clinicians to evaluate therapy options that deliver optimal outcomes for their patients while ensuring that health care dollars are invested most efficiently. So, the key findings of this study show that intraoperative radiation therapy allows a balance between these two critical factors for selected patients. It can potentially drive down the cost of breast cancer treatment while maintaining the patient's overall outcome and quality of life.


"In the U.S., there are approximately 60,000 new cases annually of in situ breast cancer. That is a daunting number. As a doctor, it is my responsibility to guide and treat these patients throughout their course of care, and that also includes educating them on all of their available treatment options. EBRT, considered to be the most common form of radiotherapy, is a lengthy treatment course (from 3 to 6 weeks), and quite frankly, some patients may be unable to commit to this; some may find it stressful; some may be looking for a different, improved patient experience. Therefore, conducting this research to determine the value of intraoperative radiation therapy as a meaningful treatment option for early-stage breast cancer was important."


2 Besides costs, what were some of those health benefits and quality-of-life benefits that women who underwent intraoperative radiation therapy had?

"Because EBRT delivers radiation to the whole breast, it can potentially cause radiation damage to surrounding healthy tissues and critical structures, such as the heart, lungs, and ribs. The study found that external beam radiation potentially exposed patients to four times more radiation than intraoperative radiation therapy, which could translate into greater than 15 times relative risk of longer-term complications.


"In addition, intraoperative radiation therapy treatments are shorter and, because of the more targeted radiation delivery, there are fewer patient side effects. These factors enable patients to return to their normal daily lives more quickly, reducing emotional stress, travel to and from doctors' appointments, days off work, and more.


"We hope this information will create awareness and better educate affected women about all of the treatment options available to them so they can make informed decisions. While not everyone will be a good candidate and approved to receive treatment for intraoperative radiation therapy, for those who are, they should fully understand this alternative, [and] its potential benefits and cost savings."


3 So what is the bottom line that practicing oncologists and cancer care providers should know about this research?

"As the U.S. health care system continues to move from a payment system relying on volume to one that relies on value, it's important for all clinicians to continue enhancing their quality of care [by] evaluating and identifying which therapies provide the best overall value and benefits for their patients, while also ensuring that health care dollars are being invested efficiently.


"By implementing highly effective, state-of-the-art technologies that save the health care system money while simultaneously providing effective patient outcomes, [like] targeted therapies such as intraoperative radiation therapy, clinicians are on the right track to achieving unprecedented success in this new era of value-based care."