Guideline Concordant Treatments Associated with Lower Costs in Early-Stage Breast Cancer


Nearly one in five women with early-stage breast cancer received guideline-discordant treatment, usually with regards to chemotherapy use, according to research presented at the San Antonio Breast Cancer Symposium (December 5-9, 2017; San Antonio, TX).

Guideline-concordant treatment was further associated with reductions in health care costs and improvements in health care resource utilization within the parameters of the study.

Payers have begun to limit reimbursement for medical care that is not concordant with National Comprehensive Cancer Network guidelines. Little research has focused on treatment regimen concordance in patients with early-stage breast cancer.

Gabrielle Rocque, MD, assistant professor at University of Alabama at Birmingham, and colleagues conducted a retrospective analysis of 1042 older women (aged 65 years or older) diagnosed with stage I to stage III breast cancer between 2012 and 2015. Researchers observed concordance based on type of treatment, including chemotherapy, hormone therapy, and HER2 targeted therapy.

Researchers found that 82% of women received guideline-concordant therapy. The majority (79%) received a preferred treatment; 3% were treated with a nonpreferred treatment that was considered on-guideline.

Significant factors associated with guideline-concordant treatment receipt included white race, treatment at a high-volume medical center, earlier stage cancer, estrogen- or progesterone-receptor positive tumors, and negative HER2 status (P < .05 for all).


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Chemotherapy receipt was observed in 496 patients, 63% of whom received guideline-concordant therapy. Guideline-concordant patients receiving chemotherapy experienced lower costs averaging $1464 (95% CI, $1135-1793; P < .001).

Guideline-concordant patients also experienced 41% lower adjusted emergency department visits (per thousand visits, 51.3 per month vs 77.9 per month) and hospitalizations (28.2 per month vs 42.7 per month).

“The appropriateness of guideline deviation should be examined from both the patient and payer perspectives,” researchers concluded.—Cameron Kelsall