It is not uncommon for patients with breast cancer in rural south to run hundreds of kilometers to reach medical practice led by Dr. Phillip Ley, Mississippi cancer surgeon.
For those who are good candidates, Ley recommends therapy that offers a single dose of targeted radiotherapy to the breast tissue of a patient immediately after surgery to eliminate a tumor. Known as peroperative radiotherapy, or Iort, it costs patients in time and money less than traditional radiotherapy treatments, and it is much less exhausting.
“For our patient population here, [IORT] Was such a boon because we have so many rural patients, “said Ley, director of oncology services at Merit Health Surgical Oncology.” I have patients who do not have enough gas money to go to radiation every day. ”
But the treatment is not as widely available in the United States as in the past, according to interviews with a dozen breast surgeons. They argue that it is because it reduces the income of doctors and hospitals that rely on the much greater sums of money generated by traditional radiotherapy treatments.
Oncologists’ radiations that carry out the IORT receive approximately $ 525 per treatment, 2022 medication estimates show, much less than the $ 1,300 they receive in whole mammary radiation with five sessions and the $ 1,730 generated by 15 sessions. Hospitals also benefit from repeated radiation sessions, which generate installation costs each time a patient returns for care.
Breast cancer surgeons receive the same quantity, whether he gets a patient, an entire breast irradiation or partial breast irradiation.
“This is money and greed,” said Ley.
Iort, that the Food and Drug Administration approved in 1999, is not for each patient with breast cancer. Ideal candidates are menopausal women with tumors at an early stage and very small tumors and no proof of involvement of lymph nodes.
During the decades which followed the introduction of the IORT, he was the subject of in -depth research showing the recidivism of cancer slightly higher than for the irradiation of the entire breast. In addition, approximately 1 in 5 out of 5 patients ends up supplanting treatment with an entire breast irradiation after subsequent pathology reports show cancer in their lymph nodes or near eliminated tumors.
But the IORT has similar long -term survival results and lower mortality rates than other cancers, and it eliminates the potential of skin burns and damage caused by potentially fatal radiation to lungs and hearts, according to research and breast cancer studies.
The American Society for Radiation Oncology, or Astro, the Medical Society for Professionals performing radiotherapy to treat cancer and other diseases, does not recommend Iort to patients outside clinical trials, citing its higher recurrence rate.
Dr. Cathryn Yashar, president of the health policy and elected president of Astro, said that money was not a factor in his position on Iort.
“Astro’s work is to objectively assess the data and give doctors and patients a decision for decision -making,” said Yashar, chief of the San Diego health system of the University of California. “We do not make the decision for patients.”
Dr. Alice Police, a breast surgeon who has implemented three Iort programs in American hospitals, says that she believes that Astro’s position on innovative treatment reflects opinion among the many radiations that Iort is a disturbing technology whose lower costs and high levels of patient satisfaction threaten their income.
“Oncologist radiation is very powerful – they earn so much money for hospitals,” said the police. “Even if the [IORT] The data is great and the advantage for the patient is simply huge, they call him experimental. »»
The problem with this, said the police, is that “insurance companies will not pay for it”.
Amy Slaton, 59, of Louisiana, discovered her breast cancer early and chose to receive Iort. Her employer’s insurance scheme would not cover him, she told NBC News, so she and her husband decided to pay the treatment of their pocket.
After the operation, she said, she was back to work within two months-a feat that would not have taken place with an irradiation of the whole breast.
“My employer brought me about five weeks to two months earlier than they would have done,” Slaton said in an interview. “This is why I do not understand why my insurance company would not cover it.”
Medicare and Medicaid cover it, however.
NBC News asked AHIP, the organization of lobbying representing American health insurers, why some, including Medicare Advantage plans, refuse the coverage of the Iort.
A spokesperson said: “Health plans are working to connect patients with safe and clinically appropriate care while promoting affordability for consumers and sustainability in our health care system.”
“A precious option”
Heidi Toplansky, 72, was diagnosed with two different cancers – one in each breast – in 2012. A mother of two children living in California, Toplansky received traditional radiation to treat the tumor in one of her breasts because he was not a candidate for the Iort. The tumor of the other was, and she jumped at the opportunity to obtain alternative treatment.
Even if her surgeon ended up detecting cancer cells near the place where her tumor was, forcing her to undergo repeated episodes of whole breast radiation after the Iort, she is a big supporter of treatment.
“With Iort, it is 30 minutes with this device in the breast cavity,” said Toplansky. “With traditional radiation, this machine moves on your body 20 to 30 minutes a day for two months and you burn like a piece of meat on a barbecue grill.”
Treatment is widely available abroad – in Europe, South America and Asia – for more than two decades.
The use of the IORT increased significantly in the United States after Astro published its first guideline on treatment in 2009, according to studies. Although for some patients, technology can demonstrate “long -term efficiency and safety comparable to whole breast irradiation,” said Astro, those who choose IORT should be informed that traditional radiotherapy treatment “has a much longer assessment” for safety and efficiency.
While the IORT was accepted in the 2010s, a worrying trend was formed among radiation – their supply increased more quickly than patient demand for their services, according to 2016 research in the International Journal of Radiation ONCOLOGY, BIOLOGY, Physics.
Last year, Astro published a new, more emphatic Iort directive to “reflect recent developments in patient management”.
He said that “Iort alone is not recommended as treatment for invasive breast cancer at an early stage”, but “may be reasonable to carry out a potential clinical trial or a multi-institutional register”.
The surgeons who spoke with NBC News said they had noticed a drop in the availability of the IORT following updated Astro advice.
Dr. Frederick Barker, surgeon in Bluefield, Virginia, with privileges at Princeton Community Hospital / WVU Medicine, is a great supporter of the Iort.
“The main thing is that women, thanks to what is considered the best intentions in the medical community, are refused a precious option that is not seen in countries other than the United States,” he said. “I think we have scientists with a program.”
As American health care costs are higher, the savings and convenience of the IORT have become more convincing, according to supporters and patients. IORT treatment costs $ 8,000 to $ 10,000, say the breast surgeons, compared to $ 30,000 and upwards for whole breast irradiation. A 2018 article in Frontiers In Oncology cited research showing that IORT could save $ 1.2 billion in the American health care system over five years.
Dr. Sheldon Feldman, a breast surgeon who plays Iort at Montefiore Einstein Medical Center in the Bronx, New York, said that he thought that patients had to get involved in the push for the Iort.
“It really requires a plea, just like a lot of progress in the treatment of breast cancer,” said Feldman. “This is what will be necessary to ensure that this is available.”
