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Benefits seen in experimental breast-cancer treatment

10:23 AM, Nov 18, 2012   |    comments
Dr. Anthony Dragun, a radiation oncologist at the University of Louisville, meets with breast cancer patient Mary Scott. She is showing good results in a breast cancer trial in which women get one radiation treatment a week for five weeks, instead of the traditional five treatments daily for five or six weeks. (Photo: Kylene White,The (Louisville, Ky.) Courier-Journal)
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Laura Ungar, The (Louisville, Ky.) Courier-Journal
LOUISVILLE, Ky. -- Vickie Baker did not have time for breast cancer.

The 49-year-old Hazard resident knew she needed radiation therapy, but she couldn't imagine how she could get to University Hospital in Louisville for treatments five days a week. Not when she lives more than three hours away and babysits eight grandchildren.

But a University of Louisville study allowed her to receive radiation treatment just once a week in March and April, after a lumpectomy in January.

Baker, who is doing well today, said the experimental treatment for people with early stage breast cancer "made my life a lot easier" and showed "you can have a life other than treatment."

Dr. Anthony Dragun, a radiation oncologist at the University of Louisville's James Graham Brown Cancer Center who is overseeing the study, hopes it will make radiation treatment more accessible to women facing such obstacles as distance, transportation problems and time constraints - while also cutting treatment costs by more than half.

"Just about anyone can get to a cancer center one day a week," Dragun said. "It takes (down) the barriers of access."

Research subjects get higher doses of radiation once weekly than they would receive during each daily treatment, but less radiation during the overall five-week course of treatment. Traditional daily radiation schedules are also usually five weeks, but in some cases may be six or seven weeks.

Dragun led a study two years ago showing that about a third of Kentucky women with early stage breast cancer didn't get recommended radiation treatments after lumpectomy surgeries.

Among those least likely to get radiation were the elderly, African Americans and women in rural areas, including the Appalachian region of the state.

Women who did not get recommended radiation were 60% more likely to die during the time they were studied.

"There are so many times ... people publish (studies like these) and the ball is dropped in terms of solutions," Dragun said. "We tried to take our disparities research a step further."

He said he's hopeful about the new regimen. In his study and previous European studies, women getting weekly radiation report similar levels of side effects as those getting radiation five days a week.

Some outside experts say the approach seems promising, but one pointed to research that found drawbacks in terms of breast appearance after once-a-week treatments.

Baker, who is scheduled for a follow-up doctor visit later this month, said she's glad to play a part in advancing the science.

"Any time you do research, you know it's going to help someone down the road," she said. "To me, it's what we need to do. That's how you're going to get better equipment, better treatments, everything."

Less trips, money

Dragun's study targets women with breast cancer in Stages 0-II who have undergone lumpectomies and who may be getting chemotherapy or hormonal therapy.

He said the experimental regimen not only improves access to care, but also significantly reduces treatment costs as measured by Medicare reimbursement. Five weekly treatments total $2,901, compared with $6,884 for 25 daily treatments over five weeks.

And that doesn't count such costs as increased medical staff time for the more frequent treatments, and wear-and-tear on the linear accelerator that provides the radiation.

"It's cost-effective for the entire medical system," Dragun said, adding that it also saves patients money on transportation and potential expenses such as overnight stays near cancer centers.

But Dragun said the biggest benefit is improving access to care - which can potentially save lives, while also giving giving patients more time with their families and less time off of work.

Baker said distance was a big obstacle for her after doctors found a lump in her right breast on a mammogram in 2011 and her family physician referred her to University.

After the lumpectomy in January, she didn't hesitate to join Dragun's research.

Baker said she and family members drove to Louisville each week, returning to Hazard the same day. Noting that she frequently takes care of her grandchildren, she predicted that, if the only option were daily radiation treatments, she would simply have skipped some.

"I live so far out," she said. "One visit a week is much better."

Baker is one of 90 patients who have joined the study, which opened in January 2011 and aims to enroll 250 patients.

An article on the results among the first 42 patients has been accepted for publication in the International Journal of Radiation Oncology, and it concludes that women's tolerance of the weekly radiation compares well with recent reports of daily schedules, and the new regimen appears feasible and cost-effective.

Dr. Bruce Haffty, associate director of the Cancer Institute of New Jersey and president-elect of the American Society for Radiation Oncology, said he's aware of Dragun's research, which is one of several alternatives to daily, five-week radiation regimens being studied right now.

Haffty said radiation technology has grown more sophisticated, and such pared-down treatment schedules may someday help patients with long distances to travel.

"It is promising, but it needs to be done in the context of a trial," Haffty said. "I don't think it's something that's ready for widespread use."

Unequal treatment

If weekly regimens do become common, Dragun said they could be particularly helpful in such places as Kentucky, a largely rural state beset by doctor shortages, high levels of poverty and cancer disparities.

In his previous study, he and his colleagues analyzed the radiation rates for 11,914 women who underwent lumpectomies for early breast cancer, and found the percentages who didn't get radiation were 47.5% for women 70 or older, compared with 28.9% for those under 50; 43.8% for Appalachian women, compared with 30.4 for non-Appalachian women, and 35.4% for black women, compared with 33.6% for white women.

The study found that women without private health insurance fared worse. Among uninsured women, 34.4% didn't get radiation, compared with 27.8% for those with insurance, 34.5% for those with Medicaid and 42.1% for those with Medicare.

Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness, said some people believe that breast-cancer disparities could be eliminated simply by making screenings more available.

But she said the problem is much more complicated; "there are big issues with access to care, timeliness of care and quality of treatment for cancer."

She said even the issue of transportation isn't as simple as it seems. In rural areas, public transportation is often scarce. And "when you're on chemo and undergoing radiation, doing a commute on a (regular) bus is not ideal."

Nesbitt said new treatment schedules such as the one Dragun is studying could help - not only by reducing the number of commutes but also by improving women's quality of life. "Any time we can decrease the frequency of doctor and hospital visits," she said, "there could potentially be higher compliance with treatment."

Dragun said if his results hold up, the new treatment regimen eventually could help all early stage breast cancer patients who need radiation because less frequent treatments would be a boon to any woman juggling work and child-rearing.

"Breast cancer often strikes women in the prime of their lives," he said. "We think it's going to just benefit everybody."

The Courier-Journal

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