In the South of USA, the rural areas to be specific, hospitals are few, and are far between. This is where breast cancer patients often have to travel for hours, sometimes even hundreds of miles to seek care, reports CNBC. For many of these patients, a newer treatment called intraoperative radiation therapy (IORT) could be life-changing. However, across the US, access to this convenient, which is cost-effective, is now shrinking. Dr Phillip Ley, reports CNBC, who is a cancer surgeon in Jackson, Mississippi, treats patients who struggle to afford daily travel for weeks of radiation therapy. “I have patients that don’t have enough gas money to go to radiation every day,” he said.For women who qualify, Dr Ley recommends them IORT, a technique that delivers a single, targeted dose of radiation to breast tissue immediately after a tumor is removed. This happens in the operating room, and spares the patients the need for multiple hospital visits, thus a cheaper alternative. However, despite the advantages, IORT is disappearing from the US.Why Is IORT Losing Its Ground In US?CNBC reported that financial interests could be the reason behind IORT's decline. As per the Medicare data 2022, radiation oncologists who perform IORT earn $525 per treatment, which is far less than the $1,300 for a five-session course of radiation or $1,730 for 15 sessions. Each additional hospital visit also generates facility fees, which makes the conventional radiation therapy far more profitable. Dr Let says, "This is about money and greed." In fact a 2018 Frontiers in Oncology study estimated that IORT could save $1.2 billion over five years in U.S. healthcare costs.Who Is Eligible vs Who Is Not For IORT?This FDA-approved treatment was first cleared in 1999, however, it is not suitable for everyone. It is best for postmenopausal women, with small, early-stage tumors and no lymph node involvement. However, research does show that IORT may carry a slightly higher recurrence rate than radiation therapy. Roughly 1 in 5 patients could require a full radiation therapy afterward if additional cancer cells are revealed in pathology results. Despite this, studies show a similar long-term survival rates, lower mortality from other cancer, a fewer complications like burns or radiation damage to the lungs and heart. Still, the American Society For Radiation Oncology (ASTRO) does not recommend IORT outside clinical trials, citing recurrence concerns. Dr. Catheryn Yashar, ASTRO’s president-elect, insists the organization’s position is based purely on data, not dollars: “ASTRO’s job is to evaluate the data objectively and give both physicians and patients a framework for decision-making,” reports CNBC. However, not all doctors agree. Dr Alice Police, a breast surgeon who helped launch three IORT programs in US hospitals says, "“Radiation oncologists are very powerful — they make so much money for hospitals. Even though the data is awesome and the benefit to the patient is enormous, they call it experimental.”Another barrier is also insurance companies who often refuse to pay for IORT. However, when patients are asked, they share stories where they returned to work way before than they would have in case of traditional radiation therapy. Stories Of Relief, Stories Of FrustrationAmy Slaton, 59, from Louisiana shares such experience with CNBC. She says while she had to pay out of pocket, she was able to return to work within two months, far sooner than if she had undergone standard radiation. Heidi Toplansky, 72, from California, who was diagnosed with cancer in both breasts in 2012, of which only one tumor qualified for IORT has become an advocate for this treatment. “With IORT, it’s 30 minutes with the device in the breast cavity,” she said. “With traditional radiation, you’re burning like a piece of meat on a barbecue grill."Traditional radiation left her with severe scarring, which she later treated with lasers. Still, she says she would choose IORT again in a heartbeat.
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