Breast cancer patients regularly choose costlier, more aggressive treatment

Breast cancer patients routinely opt for longer and more costly treatments even when they are eligible for less aggressive options, according to a new study.

The report, published by consulting firm Oliver Wyman Health, found that 75% of radiation oncologists administered conventional treatment courses that last more than five weeks to breast cancer patients even though they were eligible for treatments that last between three to four weeks.

Additionally, the shorter treatment option — called accelerated radiation — is just as effective as conventional therapy and costs 25% less, the report said.

The analysis highlights the pressure physicians across the healthcare industry often feel to oblige patient preferences and desires.

"Physicians have an obligation to inform patients of treatment options available to them," said Jim Fields, a co-author of the study and partner at Oliver Wyman. "What you find is that too often we ascribe the patient demanded it as a reason for a course of action."

Physicians can also sway patients to more aggressive treatment options unintentionally.

When doctors discuss therapy options with patients, they tend to overemphasize the plan that is most aggressive because it requires more explanation, said Dr. Marty Makary, an advisor of the report and professor of surgery at Johns Hopkins School of Medicine. By the end of the conversation, patients tend to opt for the more aggressive option because it appeals to their desire for a fast solution.

For example, the number of breast cancer patients who choose to have a mastectomy has increased by 34% in the last decade even as significant evidence shows a lumpectomy — a less aggressive treatment option — delivers similar outcomes. Women who choose a mastectomy instead of a lumpectomy say they want to avoid prolonged treatment or the side effects of radiation, the report said. But evidence shows lumpectomy has a lower risk for complications and quicker recovery time than mastectomy.

To ease patients concerns, it's essential for doctors to be knowledgeable about the latest research so they can have informed discussions with patients on the benefits and risks of various treatment options, Fields said.

Makary added that there also needs to be more research on practice patterns of physicians so the industry can identify the root causes of unnecessarily aggressive treatment.

One part of the solution is also publicly showing physicians their performance data relative to their peers, Makary said. "We (physicians) are competitive."