Short Takes On News & Events

Study: Costly Breast Cancer Treatment More Common At For-Profit Hospitals

By Roni Caryn Rabin

April 28th, 2014, 6:51 AM

Older breast cancer patients who received radiation treatment after surgery were more likely to undergo a more expensive and somewhat controversial type of radiation called brachytherapy if they got their care at for-profit rather than nonprofit hospitals, a new study reports.

Among the oldest group studied – women in their 80s and early 90s who are least likely to benefit from the regimen – the odds of receiving the more expensive brachytherapy were significantly higher at for-profit hospitals, the study found.

The research, funded by the National Cancer Institute and the Robert Wood Johnson Foundation, was published Monday in the May issue of the journal Surgery.

“We wanted to see whether for-profit hospitals, which arguably have a greater incentive to provide returns to their shareholders, would be more likely to adopt a higher-reimbursement therapy than a nonprofit hospital — and that’s exactly what we found,” said Dr. Cary P. Gross, a professor of medicine at Yale University School of Medicine and the paper’s senior author.

“This reinforces the idea that reimbursement is a significant driver of the adoption of new cancer therapies, which is a shame,” Gross said. “Evidence should be the main driver.”

Brachytherapy is a newer type of radiation therapy for breast cancer that involves implanting a radiation source into the lumpectomy cavity of the breast. It is a shorter course of treatment than standard radiation and can be completed in one week instead of four to six weeks. But it costs about twice as much as the standard treatment, and recent studies have questioned its effectiveness and whether its harms may outweigh its benefits.

The retrospective study looked at the care 35,118 women between  the ages of 66 and 94 covered by the government’s Medicare program received after breast-conserving surgery for breast cancer in 2008 and 2009. The women had surgery at 2,684 hospitals in the United States; only 8 percent were treated at for-profit hospitals.

Among the patients who underwent radiation treatment, 15.2 percent received brachytherapy at nonprofit hospitals, compared with 20 percent of those treated at for-profit hospitals.

There was no association between the hospital’s status and overall radiation treatment for women aged 66 to 79, although women in that age group who received radiation at a for-profit hospital were also more likely to get brachytherapy.

Among women aged 80 to 94, who benefit least from radiation therapy because they are unlikely to live long enough for their cancer to recur, 58.9 percent received radiation at for-profit hospitals, compared with 53.9 percent at nonprofits, while 12.4 percent received brachytherapy at for-profit hospitals, compared with 8 percent at nonprofits.

For these patients, “who may not have gotten radiation to begin with,  brachytherapy is driving an overall increase in the use of radiation,” Gross suggested.

The study notes that a driving factor in using brachytherapy is the attempt to enhance convenience and tolerability. “However, it is unclear why patient preferences for radiation modality would vary with hospital ownership,” it said.

Gross said the take-home message for patients is that treatment recommendations vary from provider to provider, and they should always get a second opinion. Both physicians and members of the general public tend to become “enamored” with new treatment options, he said, even when the evidence is limited or lacking.

“Don’t just ask the doctor which type of treatment you should get,” he said.  “Ask the doctor, ‘What happens if I don’t get this treatment? How does this affect the outcome?’”


5 Responses to “Study: Costly Breast Cancer Treatment More Common At For-Profit Hospitals”

  1. steven says:

    When you go to a fast food joint, do they ever ask… Want fries with that burger? Why do they ask that? It’s not because they are worried about your health. French fries don’t contribute to your health. It’s because they want to increase profits and nothing generates more profits than french fries. Same is true about for-profit hospitals. They care more about generating profits than they do about your health or the outcome of your treatment. That’s a fact! Anyone that goes to a for-profit hospital is an complete idiot.

  2. Dawn says:

    Somewhat of a distorted report as the most significant piece of information, which is that brachytherapy is more readily tolerated and the oldest patients would benefit most, is buried at the end of the article.

    Any objective writer would also have asked:
    1) Do breast cancer patients under the age of 65 also receive newer cancer therapies? We’d have to look at both Medicare and non-Medicare patients to draw accurate conclusions about the drive for reimbursement vs. other considerations in treatment selection.

    2)Why are we dismissing patients in their 80′s and assuming no need for appropriate care? Five years is the window, or at least the younger women I know used that measure, when no recurrence indicates the breast cancer survivor is likely “cured”. Since when do we assume an 82 year old, for e.g., won’t survive till 87? Why should they not receive the best treatment – we are just condemning older women to a horrible death?

    3) What was the composition of the for-profit and not-for-profit hospital pools? Did the study control for equality in the ability to deliver cutting edge treatment? Are we comparing non-profit major medical centers and for profit major medical centers? Or, rural non-profit hospitals to major for-profit hospitals? What is the precise composition of the two pools?

    These are just some of the questions that come immediately to mind when I see this kind of “new” cost containment approach to the treatment of older Americans on Medicare – a group I am not in.

  3. Frank A. Vicini, MD says:

    I feel it’s incumbent upon me to challenge several of the facts present in this article. I am a radiation oncologist who has been performing breast brachytherapy for the better part of a decade. I am also the principal investigator of the phase three trial investigating the equivalence between breast conserving therapy with whole breast radiation vs. brachytherapy. I have been prescribing and performing the therapy based on the tremendous amount of success my patients have had had with it, as well as the level one data that supports APBI as equivalent in its efficacy to whole breast radiation therapies. To suggest that it’s a less effective treatment than others is simply not true.

    I would argue that the data discussed in this article does not indicate a reimbursement issue, but rather a quality of life issue for patients. At the time of this study (2008-2009), breast brachytherapy was considered the number one option for a shortened course of radiation treatment for elderly patients. Shortening the course of treatment is often preferable for woman of all age groups, but it is particularly important for eldery patients. Not only does is lessen potential side effects but often times transportation to and from treatments is an issue for older patients, and the ability to have the treatment completed in less than a week vs. six weeks is more efficient.

    To suggest that the cost of breast brachytherapy is double or more than that of other treatments is suspect at best. I believe it would be very difficult to provide an accurate analysis of treatment costs among so many different facilities, with multiple variables, billing codes, levels of reimbursement and other factors.

    I think I speak for all of my colleagues when I say that the treatments we prescribe are based on what is in the best interest of our patients. To suggest otherwise is unfair and unfounded.

  4. Martin says:

    Breast cancer treatment is more expensive than other treatments. There are many treatments such as radiation therapy, chemotherapy, hormonal therapy and surgery. All of them have their of side effects. If you take Ayurvedic remedies. You get faster results with minimum side effects. There are many Ayurvedic health centers, which are providing different Ayurvedic therapies for breast cancer.

  5. solanki says:

    A more important area of inquiry would have been to look at what proportion of women over the she of 70 with node neg , HRpositive T2 lesions got RT We have solid science that they could be spared at enormous savings in terms of cost and morbidity.

    The aim of the study seemed to be to find fault with for profits. What is not emphasized is that the non profits are doing the same to a large no. of pts just slightly fewer.

    The flaw is in the system that approves machinery before there is science that justifies its use.

    Think of a cancer drug that is safe. Approve it , allow it to be used and later find out what it is good for or is actually harmful or no better than what we had!!
    Would we do that?? I think not but we do with machinery!!