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Use of costly breast cancer therapy strongly influenced by reimbursement policy
Date:4/28/2011

had IMRT) compared to those treated in hospital-based outpatient clinics (5.4% had IMRT).

In their discussion, the authors note that there are two ways to achieve intensity modulation of the radiation beam, one called field-in-field forward planning and one called inverse planning. The second is more expensive, requiring more physician and treatment planning time. Most Medicare carriers require inverse planning to reimburse for IMRT, although the two approaches likely have similar outcomes for treatment of the breast only, according to the authors.

They write that their data "suggest that with respect to breast radiation therapy, much of the variation in cost can be directly attributed to inconsistent treatment definitions and reimbursement rates authorized by Medicare and its intermediaries."

In an accompanying editorial, Lisa A. Kachnic, M.D., of Boston University School of Medicine, and Simon N. Powell, M.D., Ph.D., of Memorial Sloan-Kettering Cancer Center, New York, note that the evidence supporting the routine use of inverse-planned IMRT for patients requiring breast only treatment is weak. They suggest that the true value of inverse- planned IMRT will most likely be for patients with complex anatomy or those with more advanced breast cancer who require comprehensive lymph node treatment such as radiation to the internal mammary nodal chain. IMRT may also help to protect the underlying lung and heart, they say. However large randomized trials are needed to determine whether it actually has these benefits.

In the meantime, the editorialists write, this study "appears to confirm the suspicion of many, both within and outside of the healthcare industry, that medical decision making is too heavily influenced by reimbursement rather than medical necessity."


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Contact: Kristine Crane
jncimedia@oxfordjournals.org
301-841-1287
Journal of the National Cancer Institute
Source:Eurekalert

Page: 1 2

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