Pathologic Factors Predictive of Local Recurrence in Patients with Invasive Breast Cancer Treated by Conservative Surgery and Radiation Therapy

PURPOSE To assess patients' preferences regarding the trade-off between risks and benefits of radiation therapy after conservative surgery for early-stage breast cancer. PATIENTS AND METHODS Utilities (measures of preference) of 97 early-stage breast cancer patients treated with conservative surgery and radiation therapy and 20 medical oncology nurses were assessed for five health states using standard gambles. RESULTS Patients had the highest mean utility for treatment with conservative surgery and radiation therapy without a local recurrence (0.92), intermediate utilities for treatment with conservative surgery alone followed either by no local recurrence or by a local recurrence salvaged by conservative surgery and radiation therapy (0.88 and 0.87, respectively), and the lowest utilities for treatment with or without radiation therapy followed by a local recurrence salvaged by mastectomy and reconstructive surgery (0.82 and 0.81, respectively). All differences between health states' utilities were significant (P < .0001), except between the two intermediate and two lowest rated health states. None of the clinical or sociodemographic factors examined explained more than 5% of the variability in the patients' utilities or their differences. Nurses' utilities were similar to those of the patients. CONCLUSIONS These results strongly suggest that fear of a local recurrence and an actual local recurrence leading to mastectomy have such a negative impact on quality of life that patients are willing to accept the risks and inconvenience of radiation therapy to avoid them. There is also considerable interpatient variability that was not explained by the clinical or sociodemographic factors examined.

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Identification of Patients at High Risk for Local Recurrence After Conservative Surgery and Radiation Therapy for Stage I or II Breast Cancer

Archives of Surgery ◽

10.1001/archsurg.1987.01400230034005 ◽

1987 ◽

Vol 122 (11) ◽

pp. 1248 ◽

Cited By ~ 46

Author(s):

Robert T. Osteen

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

High Risk ◽

Local Recurrence ◽

Conservative Surgery ◽

Stage I

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Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.3.1022 ◽

1998 ◽

Vol 16 (3) ◽

pp. 1022-1029 ◽

Cited By ~ 77

Author(s):

J A Hayman ◽

B E Hillner ◽

J R Harris ◽

J C Weeks

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Radiation Therapy ◽

Cost Effectiveness ◽

Local Recurrence ◽

Early Stage ◽

Cost Effective ◽

Conservative Surgery ◽

The Cost

PURPOSE To examine the cost-effectiveness of radiation therapy following conservative surgery for early-stage breast cancer. METHODS Using a Markov model, a cost-utility analysis was performed to compare a strategy of radiation therapy versus no radiation therapy in a hypothetical cohort of 60-year-old women following conservative surgery. Local recurrence, distant recurrence, and survival rates used in the model were derived from randomized trial data. Utilities for the nonmetastatic health states were collected from actual patients. Direct medical costs were estimated using data from a single institution. Transportation and time costs were also estimated. Years of life, quality-adjusted life-years (QALYs), costs, and incremental cost/QALY over a 10-year time horizon were calculated by the model for each strategy. RESULTS The addition of radiation therapy results in a cost increase of $9,800 per patient, no change in life expectancy, and an increase of 0.35 QALYs per patient, which leads to an incremental cost-effectiveness ratio of $28,000/QALY, which is well below $50,000/QALY, a commonly cited threshold for cost-effective care. Sensitivity analysis shows the ratio to be heavily influenced by the cost of radiation therapy and the quality-of-life benefit that results from decreased risk of local recurrence. CONCLUSION Radiation therapy following conservative surgery is cost-effective compared with other accepted medical interventions. This study illustrates the importance of considering an intervention's effect on quality of life, as well as survival in defining cost-effectiveness.

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