Use of Costly Breast Cancer Therapy Influenced Strongly by Reimbursement Policy and Practice Setting

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What Medicare would pay for and where a radiation oncologist practiced were two factors that strongly influenced the choice of intensity-modulated radiation therapy (IMRT) for treating breast cancer, according to an article published April 29 online in the Journal of the National Cancer Institute . The use of IMRT and the cost of radiation therapy increased sharply over the period of the study.

IMRT is a radiation delivery technique that modulates the radiation beams to conform to the shape of the tumor or tumor bed in an attempt to maximize the dose of radiation to the tumor while minimizing the dose to adjacent normal tissues. Compared to conventional, two- or three-dimensional radiation therapy, IMRT may reduce acute skin toxicity and improve cosmetic outcomes for women undergoing breast conservation therapy.

But there are simpler approaches to three-dimensional treatment that may provide the same benefits at lower cost. It is thus controversial whether such treatments justify billing Medicare for IMRT.