An Innovative Treatment Option for Early-Stage Breast Cancer

By Olga Ivanov, MD and Rakesh R. Patel, MD | Published 1/19/2018 0

early stage breast cancer

It’s not surprise that spending on healthcare is rising faster than ever before. In 2016, U.S. healthcare spending increased 4.3% to reach $3.3 trillion, or $10,348 per person. While the increased costs are causing most Americans to shudder, what’s especially devastating is the burden it brings to those who are sick or diagnosed with a life-threatening disease, such as cancer.

Every year, more than 60,000 women in the U.S. are diagnosed with early-stage breast cancer. Although it can be challenging to pinpoint the exact cost of treating breast cancer, it could be as much as $20.5 billion by 2020 in the U.S. alone—higher than any other type of cancer. For uninsured patients, this can be financially devastating, costing anywhere from two to 43 times what Medicare would pay for chemotherapy, as well as higher rates for physician visits. Even with health insurance, many still may not be able to afford their medical bills, as co-pays and deductibles also continue to rise.


Innovative treatment option for early-stage breast cancer

The good news? There are innovative technologies now available that offer alternatives for breast cancer treatment that are not just more economical for breast cancer patients, but the overall U.S. healthcare market as well. One such technology is intraoperative radiation therapy (IORT), a radiation treatment that uses a miniaturized x-ray source to deliver a full course of targeted radiation inside the body, directly within the tumor cavity at the time of breast conserving surgery (lumpectomy). IORT allows radiation oncologists and breast cancer surgeons to work together to offer appropriately selected patients an option to avoid the need for six to seven weeks of post-operative external beam radiation therapy (EBRT), another common type of radiation therapy for cancer treatment. Traditional EBRT delivers radiation to the whole breast, exposing surrounding tissues and critical structures to radiation. In addition, EBRT requires daily radiation treatments over the course of several weeks, which can significantly impact the daily routine for many patients.

With IORT, administering the treatment is quick and simple. A surgeon removes the cancer while preserving the remaining surrounding healthy tissue, and places a small inflatable balloon inside the surgical cavity after the cancer is removed. Then, a miniaturized x-ray source is placed in the applicator, delivering radiation for the prescribed amount of time. When the treatment is complete, the x-ray source is turned off and all devices are removed. While there are multiple IORT systems on the market today, our facilities utilize the Xoft System, which has been used to treat thousands of women worldwide.

Until recently, no one had examined the quality of life and direct costs of care in treating early-stage breast cancer with IORT versus EBRT over the life of the patient, nor had anyone examined the long-term effects of radiation exposure with both therapies. However, our study published in the peer-reviewed Cost Effectiveness and Resource Allocation shows that for patients who are good candidates and approved to receive IORT, it is the preferred treatment for early-stage breast cancer versus EBRT.


Lower costs and increased patient benefits

The study found IORT to be the preferred method of treatment for several reasons. First, IORT is extremely cost-effective and is estimated to save the U.S. healthcare system more than $630 million over the lifetime of patients diagnosed annually with early-stage breast cancer. Patients can also potentially save more than $10,500 annually when receiving treatment with IORT over EBRT, reducing the direct expenses related to their care.

Aside from the significant cost savings, IORT also directly benefits patient health by minimizing their exposure to radiation. Because EBRT delivers radiation to the whole breast, it can cause radiation damage to surrounding healthy tissues and critical structures, such as the heart, lungs, and ribs. The study found that as a whole, EBRT exposed patients to four times more radiation than IORT, which translates into greater than 15 times relative risk of longer-term complications. In addition, IORT 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. Overall, the study concluded that IORT provides better health outcomes and offers patients a better quality of life.

Clinicians are also encouraged by the technology because it fosters collaboration between surgeons and radiation oncologists, enabling them to deliver the full course of treatment in minutes in just one day. In addition, a growing body of positive clinical research shows that IORT with the Xoft System is a safe and effective treatment for patients meeting specific selection criteria. Having the ability to offer patients this type of innovative treatment is of utmost importance to clinicians, as it not only improves their patients’ satisfaction levels, but also positions them and their facilities as leaders in patient-centric, cutting-edge medicine.


The financial side of value-based care

As the U.S. healthcare system continues to move from a payment system relying on volume to one that relies on value, clinicians will have to continue to enhance their quality of care and spend more time evaluating and identifying which therapies provide the best overall value for their patients, while also ensuring that healthcare dollars are being invested efficiently.

By implementing highly-effective, state-of-the-art technologies that save the healthcare system money while simultaneously providing improved patient outcomes, such as IORT, clinicians are on the right track to achieving unprecedented success in this new era of value-based care.

Olga Ivanov, MD and Rakesh R. Patel, MD

Olga Ivanov, MD (L) is a board-certified and fellowship-trained breast surgeon at Florida Breast Health Specialists and the Medical Director of the Comprehensive Breast Health Center at Florida Hospital Celebration Health. Her primary areas of specialty include accelerated partial breast irradiation, breast reconstruction, lumpectomy, mastectomy, ultrasound and stereotactic breast biopsies, gynecomastia management, Intraoperative Radiation Therapy (IORT), assessment of breast cancer risk factors, and genetic testing and counseling. She applies state-of-the-art diagnostic tools and techniques for detecting, staging and treating most forms of breast cancer, and for preventing it from recurring. A graduate of the Medical College of Ohio in Toledo, she undertook her residency training in general surgery at Loyola University Medical Center followed by an advanced fellowship in breast surgery at Northwestern Memorial Hospital in Chicago. Follow her @OlgaIvanovMD

Rakesh R. Patel, MD (R) is a renown Radiation Oncologist in the Bay Area, California. He is a Past President of the American Brachytherapy Society and has given lectures around the world on targeted cancer therapy and breast cancer. He is a co-founder of _blank">TME (Targeted Medical Education), which leads several breast cancer physician education and research initiatives. Dr Patel has over 100 peer-reviewed publications and scientific presentations. He graduated from Indiana University School of Medicine and completed a residency at University of Wisconsin Hospital in 2004. He currently leads the Breast Cancer program and Department of Radiation Oncology at Good Samaritan Hospital in Los Gatos, CA. Follow him @DrRakeshPatel

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