August 30, 2016 — A recently published study identifies two key research findings regarding breast cancer treatment options. First, breast conservation treatment (BCT), i.e. lumpectomy plus radiation therapy, delivered in a community setting resulted in overall survival rates that are higher than the national average. Second, BCT resulted in overall survival rates that are higher than the national average when compared to other available treatment options.1
The study was published in The Journal of Community and Supportive Oncology.
“We have been treating breast cancer patients in the community setting for several decades and believe we have positively influenced the level of quality care,” said Leslie Botnick, M.D., chief medical officer for Vantage Oncology. “We conducted this study because breast cancer is one of the most commonly treated cancers in radiation oncology. It is very often treated in community settings across the country where many of our affiliated centers have a footprint. We now have demonstration that breast cancer treatment in the community setting has excellent results, with survival rates as good, if not better, than the national average, which includes treatment in the hospital setting.”
“The other bottom line result was that BCT offers excellent survival rates, supporting the idea that breast conservation inclusive of radiation reflects quality care,” said Vantage radiation oncologist May Lin Tao, M.D. “There is a worrisome pendulum swing nowadays away from breast conserving surgery and radiation in situations that are still quite amenable to this approach. These data give excellent reassurance that patients can have superb survival results with this BCT rather than more aggressive surgical options.”
Tao added, “These results are achievable in community settings when care is well-coordinated among specialists who are invested in a high level of care. Often times, women don’t get all of their expected treatment after surgery, such as radiation therapy. We have been fortunate to implement a virtual multidisciplinary care program in our community practices, building on the local expertise of breast surgeons, medical oncologists, radiologists and pathologists.”
The study was funded by Vantage Oncology, and co-authored by Vantage Oncology and Valley Radiotherapy Associates Medical Group (VRA) physicians and clinicians. The purpose of this collaborative research was to determine the rates of positive clinical outcome of BCT in a large urban community and overall survival after conservation therapy, and compare these with national rates.
As part of the study, 1,172 patients diagnosed with T1-2, N0 breast cancer from 1997-2007 were identified in the Providence St. Joseph Medical Center, Burbank, Calif. hospital tumor registry. These results were compared to the rates of BCT and receipt of radiation therapy with a similar population in the SEER [Surveillance, Epidemiology, and End Results] database (N = 232,898) for the same treatment period.
Results showed the rate of breast-conserving surgery (BCS) or lumpectomy was higher in the studied practice compared with the national average (90.9 percent and 66.4 percent, respectively). Similarly, the rate of receipt of radiation after BCS in the studied practice was 93.7 percent, which was also very high as compared to the national average of 74.4 percent. Most importantly, the survival estimates were higher for patients treated with breast conserving surgery plus radiation in the studied practice across all age groups (92.5 percent) compared with the national estimates (82.4 percent).
Botnick noted, “The quality care metrics of rate of breast conservation and the receipt of radiation therapy after BCS were very high in our community setting. That rate has been shown to vary substantially by geographic region in the U.S. rather than by medical indication, with omission rates exceeding 30 percent in some areas2. Furthermore, pooled analyses have shown that omission of radiation after BCS results in higher breast recurrence rates and even a small increase risk in patient mortality.3”
In an effort to progress toward value-based payments from the traditional fee-for-service model, Vantage’s affiliated physician practice in California, VRA, recently partnered with Anthem Blue Cross of California in an agreement to create a single episode-of-care payment for patients with a breast cancer diagnosis requiring radiation therapy treatment.
“We feel one of the reasons we were able to partner with a large payor like Anthem was because we have demonstrated we can provide effective care at a sustainable cost. This is appealing to a payor entity looking to make sure the level of care and patient satisfaction provided to its beneficiaries is high and value-based,” added Botnick.
For more information: www.vantageoncology.com
1 Tao ML, Mautner BD, Ray HE, et al. Long-term Community-based Results of Breast Conserving Therapy in Early-stage Breast Cancer. JCSO 2016; 14:249-254.
2J Clin Oncol (2002) 20(21): 4381-93)
3 JNCI J Natl Cancer Inst (2004) 96(2): 115-121