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Costs of long-course palliative radiotherapy acceptable in late-stage lung cancer

December 20, 2006

A longer, less intense course of radiotherapy provides better value for the money than a shorter, more intense regimen when given to ease pain and other complaints in patients with late-stage non-small-cell lung cancer (NSCLC), according to a study in the December 20 issue of the Journal of the National Cancer Institute.

Patients with late-stage NSCLC are often too ill to receive intensive treatment for their cancer. Palliative radiotherapy is given to ease symptoms such as chest pain and difficulty breathing and swallowing. In 1999, Wilbert B. van den Hout, Ph.D., of Leiden University Medical Center in the Netherlands, and colleagues conducted a randomized clinical trial in 297 patients with inoperable stage IIIA/B or stage IV NSCLC to compare two palliative radiotherapy regimens-a short course, two treatments of 8 gray (Gy) of radiation each, with a long course, 10 treatments of 3 Gy each. They found that the long course better eased symptoms over time and improved 1-year survival compared with the short course.

However, that study did not take into account the higher costs of the longer treatment and the continued medical costs of the patients who survive longer with their cancer. For this new study, van den Hout and colleagues conducted a cost-utility analysis of the two treatments to see which offers the best value for the money. Using data from a patient questionnaire on factors such as their mobility, ability to perform usual activities, and pain and anxiety levels, the authors calculated that quality of life was roughly equal in both treatment groups. However, because life expectancy was longer in the long-course treatment group, that group's overall quality-of-life benefit was greater than that in the short-course group.

The researchers also estimated the costs associated with the treatment and other nontreatment costs, such as medical care for people who survived their cancer. They estimated that the lifetime societal costs of the long-course radiotherapy were $16,490 and the short-course radiotherapy costs were $11,164, a $5,326 difference. In their final calculations, the authors found that, although the dollar costs of the long-course radiotherapy were higher than those of the short course, the benefit in improved survival meant that the long-course treatment yielded benefit at an acceptable cost by current economic standards.

"In our group of poor-prognosis non-small-cell lung cancer patients, the additional costs of the protracted radiotherapy schedule were justified by longer survival rather than by improved quality of life," the authors conclude.

The authors point out that their study does not show that long-course radiotherapy reduces costs. In addition, areas with limited radiotherapy facilities may find it more efficient to treat patients with the shorter course. Finally, different countries and regions may have different economic factors that influence the decision of which radiotherapy regimen to use.

Journal of the National Cancer Institute