SHAFAQNA – When it comes to early-stage breast cancer, more treatment isn’t always better — that’s something Ontario experts already know. But in the United States, a new study says two thirds of women who have had a lumpectomy are undergoing longer radiation therapy than may be necessary.
In contrast, two thirds of Ontario women undergo shorter radiation treatment — consisting of fewer but higher-doses — which has been shown to be as effective, more convenient, less costly and preferred by patients.
“(The Ontario rate) is terrific,” says the study’s lead author Dr. Justin Bekelman, assistant Professor of Radiation Oncology at the University of Pennsylvania’s Abramson Cancer Center.
“Patient-centered care has to take into account the convenience of treatment and it certainly seems like in Canada there’s a greater proportion of patients receiving the more convenient, yet still curative, treatment,” he told the Star.
The study published Wednesday in JAMA, the Journal of the American Medical Association, looked at shorter versus longer radiation therapy in the U.S. It focuses on women with early-stage breast cancer who had a lumpectomy — surgery to remove the cancer, but not the breast — followed by whole breast radiation, which is often recommended to reduce recurrence and improve survival.
The study’s authors wanted to know how practices have changed in recent years given the publication of landmark studies and updated guidelines that support shorter radiation therapy. One of those seminal studies was done in 2002 by the Ontario Clinical Oncology Group, which in 2010 published updated findings that showed radiation over three weeks was just as effective in controlling cancer and produced the same cosmetic results as treatment over five weeks.
And in 2011, the American Society for Radiation Oncology updated its guidelines, endorsing shorter treatments for some patients saying it was equally effective for tumor control and comparable in long-term side effects.
In Ontario — and in the United Kingdom — shorter radiation treatment is the norm. But not in the U.S., where less than one third of women in 2013 received three-week treatment — the rates, however, have been rising.
Bekelman and his colleagues looked at data from 14 commercial insurance plans. They compared women undergoing the conventional five-to-seven weeks of daily radiation therapy, with those doing treatment over three-to-five weeks.
They looked at 15,643 patients and separated them into groups: One included those over age 50, who had not done chemotherapy and whose cancer had not spread to the lymph nodes. The other was comprised of women younger than 50, or who had undergone chemotherapy or whose cancer had spread.
In the first group, the number of women undergoing shorter therapy increased from 10.6 per cent in 2008 to 34.5 per cent in 2013. And among the second group, rose from 8.1 per cent in 2008 to 21.2 per cent in 2013.
By comparison, an Ontario study published last year shows that in 2008, 71 per cent of women whose cancer hadn’t spread to the lymph nodes, received radiation therapy over three weeks. Just 6.3 per cent of Ontario patients received treatment over six weeks.
When American researchers looked at a comparable sample of U.S. patients, their data showed 72.1 per cent underwent radiation treatment for six weeks or longer.
In Ontario, experts have long preferred shorter treatment because it’s more convenient for the patient and a more efficient use of resources, says Dr. Padraig Warde, provincial head of the Radiation Treatment Program for Cancer Care Ontario.
When it comes to treatment practices, Ontario is “ahead” of the U.S., says Warde, attributing that, in part, to the centralized nature of care at the province’s 14 cancer centres.
“That’s our priority at Cancer Care Ontario, we want to make sure patients are receiving cancer treatment that is safe, effective and meets the highest quality standards,” said Warde.
Three-week radiation therapy has been the standard practice in Ontario since 2002.
“It has been our standard of care because it is safe and effective for patients, and it is also a cost-effective treatment,” says Dr. Anthony Fyles, radiation oncologist at Princess Margaret Cancer Centre.
As for why more American doctors don’t prescribe shorter treatment, Bekelman suspects there are various reasons: They aren’t trained like Canadians; are concerned about long-term side effects; and are apprehensive there will be scarring and the breast won’t look as nice.
“Often we think more is better in cancer care,” says Bekelman. “And getting those physicians, and patients, to be comfortable with the idea that less is equivalent and even better, because you get home sooner and back to work sooner, takes some discussion.”
Source : http://www.thestar.com/