Cost Implications of an Evidence-Based Approach to Radiation Treatment After Lumpectomy for Early-Stage Breast Cancer.

INTRODUCTION: Breast cancer treatment costs are rising, and identification of high-value oncology treatment strategies is increasingly needed. We sought to determine the potential cost savings associated with an evidence-based radiation treatment (RT) approach among women with early-stage breast cancer treated in the United States. PATIENTS AND METHODS: Using the National Cancer Database, we identified women with T1-T2 N0 invasive breast cancers treated with lumpectomy during 2011. Adjuvant RT regimens were categorized as conventionally fractionated whole-breast irradiation, hypofractionated whole-breast irradiation, and omission of RT. National RT patterns were determined, and RT costs were estimated using the Medicare Physician Fee Schedule. RESULTS: Within the 43,247 patient cohort, 64% (n = 27,697) received conventional RT, 13.3% (n = 5,724) received hypofractionated RT, 1.1% (n = 477) received accelerated partial-breast irradiation, and 21.6% (n = 9,349) received no RT. Among patients who were eligible for shorter RT or omission of RT, 57% underwent treatment with longer, more costly regimens. Estimated RT expenditures of the national cohort approximated $420.2 million during 2011, compared with $256.2 million had women been treated with the least expensive regimens for which they were safely eligible. This demonstrated a potential annual savings of $164.0 million, a 39% reduction in associated treatment costs. CONCLUSION: Among women with early-stage breast cancer after lumpectomy, use of an evidence-based approach illustrates an example of high-value care within oncology. Identification of high-value cancer treatment strategies is critically important to maintaining excellence in cancer care while reducing health care expenditures.

Overweight among children younger than 3 years in a low-income patient population: prevalence in 2010.

OBJECTIVES: To examine the prevalence and correlates of overweight and obesity among patients aged 0 to 2 years, and to compare 3 measures of early childhood weight status, weight-for-age, weight-for-length, and body mass index-for-age. SETTING: Well-child visits in the Philadelphia Health Centers, public community health centers providing primary health care to predominantly low-income residents. STUDY DESIGN: Cross-sectional. RESULTS: Using the 3 measures, 13% to 16% of boys and 10% to 13% of girls seen during 2010 were classified as high in weight. No consistent associations with feeding method were identified. "Other/unknown" race was consistently associated with higher rates of overweight than the African American reference group. Hispanic girls had higher rates of high weight-for-age and weight-for-length than African American girls. CONCLUSION: Elevated weight status emerges in a significant proportion of very young children, by all of the commonly used weight measures. There is an urgent need for appropriate clinical strategies to prevent and respond to overweight in this age group.

Severe obesity and high blood pressure among children, Philadelphia health centers, 2010.

BACKGROUND: Child obesity is a major health problem particularly affecting disadvantaged population groups. Severe obesity carries additional health risks for children. In the context of the childhood obesity epidemic, high blood pressure among children is of increasing concern. METHODS: Chart reviews were carried out to examine the prevalence of severe obesity and its association with high blood pressure measurements among randomly selected patients aged 3 to 17 years who had well-child care visits at 8 public community health centers during 2010. RESULTS: A majority of the 691 patients reviewed were African American (58%); an additional 16% were Hispanic. The prevalence of severe obesity was 7.7% (95% confidence interval = 5.8% to 9.9%) and the prevalence of high blood pressure measurements was 17.5% (95% confidence interval = 14.8% to 20.6%). Patients who were severely obese were more than twice as likely as other children to have high blood pressure values. CONCLUSIONS: Severe obesity is associated with substantially increased frequency of high blood pressure measurements in children, and should be investigated further as a potential marker for hypertension in children. Primary care providers should be prepared to diagnose and treat hypertension in severely obese children.