When people hear the word “cancer” they naturally become very fearful for their future. Cancer is a terrifying diagnosis to receive and can leave patients feeling uncertain, desperate, confused, yet also motivated to do whatever is in their power to get fight it. This fear can lead to situations where patients are more likely to follow provider recommendations without question. While people in the healthcare field are often there because they have committed their life to helping others, more collaboration between providers and patients is necessary and can only be beneficial. For Annie Dennison of Orange County, CA, her fear is that she received an unnecessarily high amount of radiation while being treated for breast cancer.
As a part of her cancer treatment, Dennison had a lumpectomy, chemotherapy along with other medications, and underwent 6 weeks of radiation treatment. Looking back, Dennison said she agreed to 6 weeks of radiation treatment because she did not know that she had another option. Dennison was afraid that she had been exposed to more radiation than necessary. Given that there is now a 3 week long radiation treatment course available, her fears are not completely unwarranted. What the article failed to explain, however, is that the shorter option gives a higher daily dose than the longer option, and that this can increase the toxic effects in comparison to a lower daily dose. Those toxic effects are not seen right away and can take many years to develop. The NPR article publishing Dennison’s story also provides links to medical publications that they claim discuss the evidence that shorter radiation treatment schedules have been shown to be just as effective as the longer course of radiation. What the author does not immediately make clear is that these publications and research found this to be true for specific populations of patients, meaning that it cannot just be applied to every cancer patient.
Different requirements for shorter radiation time
As Dennison’s oncologist makes clear later in the NPR article, she did not fully meet the requirements laid out by the American Society for Radiation Oncology (ASTRO) to receive the shorter treatment. ASTRO endorses this shorter course if patients meet the 4 criteria highlighted in their article, while emphasizing that a lack of meeting all of the criteria should not prohibit the use of the shorter course. One of the criteria that ASTRO included for patients if they are going to receive the shorter radiation treatment is that they not have had chemotherapy. Dennison had received chemotherapy. ASTRO also said that given the extensive amount of evidence on the longer course of treatment, it is perfectly reasonable for providers to choose this option over the shorter version when treating patients. Ultimately, the treatment decision depends on provider preference and experience along with current guidelines. The decision should be made in unison between the provider and patient.
The NPR article also cited a publication in the New England Journal of Medicine that showed a condensed three-week course of radiation is just as effective as the longer course. They did not include, however, the information published in the source that highlights how potential damaging effects of shorter term but higher dose radiation can remain hidden for many years. This is one of the reasons why the shorter course radiation has not been widely adopted. Publishing snippets from sources in this manner can be misleading to the reader and should be avoided, especially when the goal is to empower patients to actively participate in their healthcare. Empowerment comes from education and education is only effective when transparency is used.
Does overtreatment occur due to fear?
That being said, this article brings up some important concerns regarding cancer treatment. In a country that spends more per year on healthcare than any other country, we still have some of the worst health outcomes among developed nations. Overtreatment is common in the United States for many conditions, and cancer is no exception. This is partially due to the fear that cancer gives patients and their loved ones. Naturally the diagnosis will make them want to do everything possible to fight the disease. This is where provider and patient education comes in. Providers should stay on top of the everchanging guidelines so that they can ensure that they are providing appropriate care. This should also encourage patients to engage in educating themselves about their condition and treatment options, and should also motivate them to be their own advocates.
Additionally, the general public needs to remember that healthcare decisions are not just made by reading a new guideline. Providers use a combination of guidelines, experience, and analysis of each patient’s individual situation to help them make decisions that they think will be the most effective. By building a trusting patient-provider relationship, and healthcare providers being thorough about discussing all possible treatment options with patients, patients can feel empowered that they are truly caring for themselves in the best way possible. Had Dennison’s provider discussed the shorter radiation course with her, perhaps she would not have been as concerned about the care she had received.
What does this mean for patients?
The shorter course radiation option is definitely a promising option. More research is still needed to determine what the long-term effects of the increased daily radiation dose will be. That being said, for patients who are eligible to receive the shorter course, all providers should be offering it. The shorter option has the potential to increase access to care by offering a more cost effective and convenient radiation treatment method.
While it can be argued that the importance of the patient-provider relationship is being recognized more now than it was in the past, we still have work to do. Providers should take the time to educate their patients and be transparent about their options. Patients should work to be their own advocate so that they can ensure they are getting a clear picture of their options during their treatment plan development.
So, does this information mean that breast cancer patients are receiving too much radiation? Unfortunately, the answer is not crystal clear. Given that we know patients nationwide are being overtreated for a variety of conditions, it seems logical to think that the same is occurring with cancer patients. However, the emotional complexities that come with a cancer diagnosis, and how this can affect care should not be overlooked. Hopefully research on shorter course radiation treatment will continue, and providers will continue to become more willing to adopt it where appropriate.