Brooke C Bredbeck1,2, Alison S Baskin2,3, Ton Wang1,2, Brandy R Sinco2, Nicholas L Berlin1,2, Sarah P Shubeck4, Nicole M Mott2,3, Rachel A Greenup5, Hari Nathan1,2, Tasha M Hughes1,2, Lesly A Dossett6,7. 1. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. 2. Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA. 3. University of Michigan School of Medicine, Ann Arbor, MI, USA. 4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Department of Surgery, Yale Medicine, New Haven, CT, USA. 6. Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA. ldossett@umich.edu. 7. Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA. ldossett@umich.edu.
Abstract
BACKGROUND: In most women ≥ 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy rates remain high. While treatment side effects are well documented, less is known about the incremental spending associated with SLNB and adjuvant radiotherapy. METHODS: Using a statewide multipayer claims registry, we examined spending associated with breast cancer treatment in a retrospective cohort of women ≥ 70 years old undergoing surgery. RESULTS: 9074 women ≥70 years old underwent breast cancer resection between 2012 and 2019, with 78% (n = 7122) receiving SLNB and/or adjuvant radiotherapy within 90 days of surgery. Women undergoing SLNB were more likely to receive radiation (51% vs. 28%; p < 0.001 and OR = 2.68). Average 90-day spending varied substantially based upon treatment received, ranging from US$10,367 (breast-conserving surgery alone) to US$27,370 (mastectomy with SLNB and adjuvant radiotherapy). The relative increases in 90-day treatment spending in the breast-conserving surgery cohort was 65% for SLNB, 82% for adjuvant radiotherapy, and 120% for both treatments. CONCLUSIONS: SLNB and adjuvant radiotherapy have significant spending implications in older women with breast cancer, even though they are unlikely to improve survival.
BACKGROUND: In most women ≥ 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy rates remain high. While treatment side effects are well documented, less is known about the incremental spending associated with SLNB and adjuvant radiotherapy. METHODS: Using a statewide multipayer claims registry, we examined spending associated with breast cancer treatment in a retrospective cohort of women ≥ 70 years old undergoing surgery. RESULTS: 9074 women ≥70 years old underwent breast cancer resection between 2012 and 2019, with 78% (n = 7122) receiving SLNB and/or adjuvant radiotherapy within 90 days of surgery. Women undergoing SLNB were more likely to receive radiation (51% vs. 28%; p < 0.001 and OR = 2.68). Average 90-day spending varied substantially based upon treatment received, ranging from US$10,367 (breast-conserving surgery alone) to US$27,370 (mastectomy with SLNB and adjuvant radiotherapy). The relative increases in 90-day treatment spending in the breast-conserving surgery cohort was 65% for SLNB, 82% for adjuvant radiotherapy, and 120% for both treatments. CONCLUSIONS: SLNB and adjuvant radiotherapy have significant spending implications in older women with breast cancer, even though they are unlikely to improve survival.
Authors: Arseniy P Yashkin; Rachel A Greenup; Galina Gorbunova; Igor Akushevich; Kevin C Oeffinger; E Shelley Hwang Journal: JCO Oncol Pract Date: 2020-07-21
Authors: Brooke C Bredbeck; Nicole M Mott; Ton Wang; Brandy R Sinco; Tasha M Hughes; Hari Nathan; Lesly A Dossett Journal: Ann Surg Oncol Date: 2022-04-05 Impact factor: 5.344