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Despite evidence, doctors slow to stop radiation treatment for some cancers

Posted at 9:00 AM, Dec 18, 2014

This new year, many will promise to change their ways. But what about your doctor?

A recent study in the journal Cancer found that doctors are slow to change how they treat breast cancer patients, even when large scale clinical trials show that some treatments have no effect on survival.

“I would not advocate any change in treatment that would cause us to have worse outcomes as we have now,” said Rachel Blitzblau, a radiation oncologist at Duke and author of the study. “The question is, can we get just as good outcomes as we have now but do less in terms of side effects and cost?”

Blitzblau reviewed the cases of elderly breast cancer patients after a large clinical trial in 2004 showed that radiation after surgery didn't improve their survival.

Years later, two-thirds of patients in that category still get radiation. So if it doesn’t work, why keep doing it?

Many doctors are uncomfortable discouraging medical care that might have a small benefit to the patient, said Matthew DeCamp, an internist and bioethicist at Johns Hopkins Berman Institute of Bioethics.

“Physicians don't see it as their primary obligation to make decisions about what’s in a patient's best interests or not based on societal costs,” DeCamp said.

They’re also wary of jumping on new treatment regimens too quickly, having learned from previous mistakes like hormone replacement therapy.

It can also be difficult for patients to forgo doing everything possible, especially if there are few side effects and the costs are covered by Medicare.

William Barrett, director of the University of Cincinnati Cancer Institute, said most women won’t miss a day of work for daily radiation treatments. The main barrier for them is time and cost.

“Some people might consider it a definitive study, others might not,” Barrett said. “I think this is useful information to know and can be part of an informed discussion that by no means is it crazy to not have the treatment after lumpectomy.”

All agreed that treatment needs to be a personal, individual assessment. Many patients older than 70 have medical issues that are more pressing than a slow growing cancer. Others are healthy and have 20 years of marathons ahead of them.

Ultimately, the treatment decision is up to the patient. Despite getting the same information about recurrence and survival, many will come to completely different conclusions.

“I make it very clear to women that we don’t have any proof that giving you this radiation will extend your life in any way,” Blitzblau said. “But some people want to everything they can possibly do.”

Breast cancer is the most common cancer diagnosed in American women, with 1 in 8 diagnosed her lifetime. Women who are 50 to 74 years old should have a screening mammogram every two years.

Gavin Stern is a national digital producer for the Scripps National Desk. Follow him on twitter at @GavinStern.