Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, Michigan Medicine, Ann Arbor, MI, USA.
Ann Surg Oncol. 2022 Feb;29(2):1051-1059. doi: 10.1245/s10434-021-10807-3. Epub 2021 Sep 23.
In most women ≥ 70 years old with hormone-receptor-positive breast cancer, axillary staging and adjuvant radiotherapy provide no survival advantage over surgery and hormone therapy alone. Despite recommendations for their omission, sentinel lymph node biopsy (SLNB) and adjuvant radiotherapy rates remain high. While treatment side effects are well documented, less is known about the incremental spending associated with SLNB and adjuvant radiotherapy.
Using a statewide multipayer claims registry, we examined spending associated with breast cancer treatment in a retrospective cohort of women ≥ 70 years old undergoing surgery.
9074 women ≥70 years old underwent breast cancer resection between 2012 and 2019, with 78% (n = 7122) receiving SLNB and/or adjuvant radiotherapy within 90 days of surgery. Women undergoing SLNB were more likely to receive radiation (51% vs. 28%; p < 0.001 and OR = 2.68). Average 90-day spending varied substantially based upon treatment received, ranging from US$10,367 (breast-conserving surgery alone) to US$27,370 (mastectomy with SLNB and adjuvant radiotherapy). The relative increases in 90-day treatment spending in the breast-conserving surgery cohort was 65% for SLNB, 82% for adjuvant radiotherapy, and 120% for both treatments.
SLNB and adjuvant radiotherapy have significant spending implications in older women with breast cancer, even though they are unlikely to improve survival.
在大多数 70 岁以上激素受体阳性乳腺癌女性中，腋窝分期和辅助放疗并不比单独手术和激素治疗更能提高生存率。尽管建议取消这些治疗，但前哨淋巴结活检（SLNB）和辅助放疗的比例仍然很高。虽然治疗的副作用有详细记录，但对于 SLNB 和辅助放疗相关的额外支出知之甚少。
我们使用全州性多支付者索赔登记处，在一个回顾性队列中对 70 岁以上接受手术的女性进行了乳腺癌治疗相关支出的研究。
9074 名 70 岁以上的女性在 2012 年至 2019 年间接受了乳腺癌切除术，其中 78%（n=7122）在术后 90 天内接受了 SLNB 和/或辅助放疗。接受 SLNB 的女性更有可能接受放疗（51%对 28%；p<0.001，OR=2.68）。基于所接受的治疗，90 天的平均治疗支出差异很大，范围从 10367 美元（单纯保乳手术）到 27370 美元（SLNB 联合辅助放疗的乳房切除术）。在保乳手术组中，90 天治疗支出的相对增加分别为 SLNB 增加 65%，辅助放疗增加 82%，两者均增加 120%。
即使 SLNB 和辅助放疗不太可能提高生存率，但对于老年乳腺癌女性而言，它们会带来重大的治疗支出。
