Association between certificate of need (CON) legislation and radiotherapy use among elderly patients with early cancers: A population-based examination.

Abstract

283 Background: High quality cancer care includes reducing overtreatment, a well-recognized problem for elderly patients with ductal carcinoma in situ (Stage 0) or Stage 1 breast cancer and low-risk prostate cancer. The federal Health Planning Resources Development Act of 1974 led to implementation of CON programs in multiple states. The stated purpose of CON is to facilitate coordinated health care services to reduce overall medical costs. We examined whether CON is associated with less radiotherapy (RT) use in elderly patients with Stage 0-1 breast cancer, and low-risk prostate cancer. Methods: We compared RT use in 6 Surveillance, Epidemiology and End Results (SEER) states with CON for radiotherapy vs. 6 states without CON for 1) men 65 years and older with low-risk prostate cancer, 2) women 70 years and older with Stage 0-1 breast cancer after lumpectomy. In both clinical scenarios, the use of RT is controversial. Patients diagnosed from 2004-2011 were included. Results: 40,267 men and 24,385 women were included. Radiotherapy use was higher in CON states: prostate cancer (64.3 vs. 56.0%, p<.001), and breast cancer (59.5% vs. 53.6%, p<.001) overall, and for each year studied (Table). RT use decreased from 2004 to 2011, but remains persistently higher in states with CON programs. On multivariate analysis controlling for age, race, stage and year, CON was associated with higher use in both prostate cancer (OR 1.46, p<.001) and breast cancer (OR 1.35, p<.001). Conclusions: There is more RT use in CON states for elderly patients who may not need this treatment for Stage 0-1 breast cancer and low-risk prostate cancer. This suggests that CON programs may not be effective in reducing overtreatment, an important quality of care issue in oncology. [Table: see text]