Medicare patients with breast cancer who received radiation treatment after surgery were more likely to undergo a more expensive and even controversial type of therapy at a for-profit rather than nonprofit hospital.
The finding, reported by Kaiser Health News, comes from research funded by the National Cancer Institute and the Robert Wood Johnson Foundation published in the May edition of the journal Surgery.
The study examined the care of 35,118 women between the ages of 66 and 94 who were covered by Medicare and received breast-conserving surgery for breast cancer in 2008 and 2009. The women visited 2,684 U.S. hospitals for care, but only 8 percent of the women were treated at for-profit hospitals.
Of the women who received radiation treatment, 15.2 percent received brachytherapy at nonprofit hospitals, compared with 20 percent at for-profit hospitals.
Brachytherapy is a newer type of radiation therapy that involves implanting a radiation source into the lumpectomy cavity of the breast, according to the report. It takes less time than standard radiation and can be completed in one week instead of four to six, but it costs about twice as much, according to the report. Further, recent studies have raised questions about brachytherapy's effectiveness and whether its risks outweigh its benefits.
"There was no association between the hospital's status and overall radiation treatment for women aged 66 to 79, although women in that age group who received radiation at a for-profit hospital were also more likely to get brachytherapy," according to the report.
Women aged 80 to 94 benefit least from radiation therapy because they are unlikely to live long enough for their cancer to recur, but among that group, 58.9 percent received radiation at for-profit hospitals compared with 53.9 percent at nonprofits. More (12.4 percent) received brachytherapy at for-profit hospitals compared with 8 percent at nonprofits.
The study notes that a driving factor in using brachytherapy is the attempt to enhance convenience and tolerability, but study authors said "it is unclear why patient preferences for radiation modality would vary with hospital ownership," according to the report.
Cary P. Gross, MD, a professor of medicine at Yale University School of Medicine in New Haven, Conn., and the paper's senior author, said the takeaway from the study is that treatment recommendations vary from provider to provider, and patients should always get a second opinion, according to the report.
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