NLM Director’s Comments Transcript
Use of Short Term

Radiation Therapy: 02/17/2015

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff U.S. National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.

Short term radiation treatment (following breast cancer lumpectomies) is increasing for women but most patients receive post-surgical radiation that may be twice as long as necessary, finds a comprehensive study recently published in the Journal of the American Medical Association.

The study’s seven authors found in 2013 about 35 percent of some early stage breast cancer patients (who received a lumpectomy, or breast conserving surgery) received three weeks of clinically recommended radiation therapy instead of six to seven weeks (that was the former standard of care). The authors explained these breast cancer patients (the first of two groups) were at least 50 years old and had not received prior chemotherapy and not experienced lymph node complications. In contrast, the study found in 2008 about 11 percent of these lumpectomy patients received three weeks of clinically recommended radiation therapy instead of six to seven weeks.

Similarly, the study found in 2013 about 21 percent of a second group of early stage breast cancer patients (who received a lumpectomy) received three weeks instead of six to seven weeks of radiation therapy. The authors explain the patients within the second group were under 50 years old and received prior chemotherapy or experienced lymph node complications. In contrast, the study found in 2008 about eight percent of the lumpectomy patients (in the second group) received three weeks of clinically recommended radiation therapy instead of six to seven weeks.

Despite some recent progress in both groups, the findings suggest most early stage breast cancer patients do not receive the current clinically recommended shorter course of radiation therapy, which the authors noted is less expensive.

For example, the study found the average cost of the shorter term (three week) therapy for breast cancer patients after age 50 was about $29,000 compared to about $32,000 for six to seven week treatments. The study found the average cost of the shorter term therapy for breast cancer patients before age 50 (who had chemotherapy or lymph node complications) was about $64,000 compared to about $73,000 for treatments for a six to seven week period.

The study’s findings are based on data from 13 commercial health care insurance plans that covered about 7.4 percent of all U.S. women in 2013. More than 15,000 breast cancer patients were assessed in the study from 2008-2013.

In a news release about the research from the University of Pennsylvania Perelman School of Medicine, the study’s lead author explained the shorter term therapy (and we quote) ‘is clinically equivalent to longer duration radiation in curing breast cancer, has similar side effects, is more convenient for patients, and allows patients to return to work or home sooner’ (end of quote).

In additional comments about the study’s findings to the New York Times, Dr. Bruce G. Haffty - the chair of the radiation oncology (cancer treatment) center at Rutgers Cancer Institute in New Jersey (who was not one of the study’s authors) - explained the slow transition to shorter therapy probably is related to the success of the previous standard. Dr. Haffty told the Times (and we quote): ‘If a physician is doing five to seven weeks of radiation for 25 years, particularly if the physician is not a specialist and not in an academic medical center, you will be a bit leery about going to something new. You are comfortable with the (prior) outcomes, patients are satisfied. Now you’ve got something that perhaps costs a bit less, but you wonder: Is it as effective’ (end of quote)?

Although the JAMA study focuses on the slow but increasing diffusion of shorter term radiation therapy, the research also explains there is significant evidence to recommend the clinical efficacy and safety of the three week (instead of a six to seven week) breast cancer treatment process.

Meanwhile, MedlinePlus.gov provides some foundational information about radiation therapy (from the American Cancer Society) within the ‘start here’ section of MedlinePlus.gov’s radiation therapy health topic page.

A guide to help patients ask about the safety of radiation therapy is provided (by the American Society of Radiation Oncology) within the ‘related issues’ section of MedlinePlus.gov’s radiation therapy health topic page. In the same section, the American Cancer Society adds a supportive guide for patients and caregivers to manage radiation therapy’s side effects.

MedlinePlus.gov’s radiation therapy health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about radiation therapy as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s radiation therapy health topic page, type ‘radiation therapy’ in the search box on MedlinePlus.gov’s home page, then, click on ‘Radiation therapy (National Library of Medicine).’ MedlinePlus.gov also has a health topic page devoted to breast cancer.

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