June 15, 2017

HEALTH REFORM IS REDUCED CONSUMPTION:

Why treating breast cancer with less may be more (Ashish A. Deshmukh, Anna Likhacheva, 6/15/17, The Conversation)

For decades, breast cancer was considered such a formidable foe that doctors who treated it and women who had it wanted to use everything in their arsenal to fight it.

That included the radical Halsted mastectomy, which often took out chest muscles along with the breast and left women disfigured.

It also included lengthy radiation treatments, sometimes for as long as seven weeks (known as conventionally fractionated radiation), given every day Monday through Friday after surgery. This form of radiation comes at great cost to women and causes hardships for those who live far away from radiation clinics. [...]

Multiple randomized trials have shown that a 3- to 4-week course of whole breast radiation therapy is equivalent to a 6- to 8-week course. In fact, the National Comprehensive Cancer Network (NCCN) guidelines endorse the short hypofractionated course as the preferred approach.

Despite all this, American doctors have not widely adopted the new strategy. The reasons for this are varied, including dissemination of new findings to private practitioners and financial incentives of treating with a longer course. Our current fee-for-service reimbursement structure pays more for the longer treatment, which may be a factor in the surprisingly slow adoption of the convenient hypofractionated whole breast radiotherapy approach.

Posted by at June 15, 2017 11:27 AM

  

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