Breast cancer brachytherapy on the increase
MedWire News: The use of brachytherapy alone after breast conserving surgery (BCS) for breast cancer has increased significantly in recent years, US study results show.
The increase correlated with US Food and Drug Administration approval and Medicare reimbursement of brachytherapy technology, report Ya-Chen Shih (The University of Texas MD Anderson Cancer Center, Houston) and colleagues.
The researchers explain that brachytherapy is a method for delivering partial-breast irradiation after BCS. "It is currently used in the community setting, although its efficacy has yet to be validated in prospective comparative trials," they say.
To identify factors influencing brachytherapy use, Shih and team analyzed data from 6882 female Medicare recipients with private supplemental insurance who were diagnosed with incident breast cancer from 2001-2006.
In total, 333 (4.8%) women received brachytherapy alone (multicatheter or balloon-based), 6521 (94.8%) received external beam radiotherapy (EBRT), and 28 (0.4%) received EBRT plus brachytherapy boost.
Treatment with brachytherapy alone, as an alterative to EBRT, increased significantly over time from less than 1% in 2001, to 2% in 2002, 3% in 2003, 5% in 2004, 8% in 2005, and 10% in 2006.
Shih and co-authors point out that the most notable increases correlated with two major policy events: "First, an increase in use was noted after July 2002, correlating with FDA approval of the balloon-based breast brachytherapy device. Second, a further increase was noted after July 2004, correlating with Medicare reimbursement of treatment," they say.
Brachytherapy use was more common in women with lymph node-negative disease (odds ratio [OR]=2.19 vs lymph node-positive disease), and in those who received axillary surgery (OR=1.74 vs no axillary surgery).
Women with non-health maintenance organization (HMO) insurance (OR=1.81 vs HMO insurance), and those who lived in areas with higher median income (OR=1.58 for the second vs lowest quartile), a lower density of radiation oncologists (OR=1.78 for the second vs lowest quartile), or higher density of surgeons (OR=1.57 for the first vs fourth quartile) were also more likely to receive brachytherapy.
"Our results suggest that the availability of clinical evidence demonstrating treatment efficacy is unlikely to have been the major force determining diffusion of this new technology," remark Shih et al in the Journal of Clinical Oncology.
"Instead, nonclinical factors, including policy and socioeconomic influences, seem to play an important role," they conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Laura Dean