Guideline-Consistent Breast Cancer Treatment Reduces Patient Costs


Patients with metastatic breast cancer who receive care aligned with National Comprehensive Cancer Network guidelines experienced less financial burden than patients who received guideline-discordant treatment.

Metastatic breast cancer treatment that is concordant with National Comprehensive Cancer Network (NCCN) guidelines can decrease direct costs for patients, according to a new study published in the Journal of the National Comprehensive Cancer Network.

As a result of high-cost treatments and care, patients often have to deal with specific cost responsibilities, such as deductibles, coinsurance, and co-payments. This financial toxicity has been linked to negative patient outcomes, including medication nonadherence, high symptom burden, and poor quality of life.

For retrospective study, researchers used the SEER-Medicare database to examine patient costs for 3709 women diagnosed with metastatic breast cancer between 2007 and 2013 who survived at least 1 year after diagnosis. Treatment regimens were matched to the version of the NCCN guidelines that were available at that exact treatment date.

Of the patients in the study, 17.6% received treatment discordant with NCCN guidelines, and these patients were more likely to be younger and more often Medicare/Medicaid dual-eligible, human epidermal growth factor receptor (HER)-negative and HER2-positive.

Overall, the findings demonstrated that for care that fits within contemporary NCCN guidelines, the median patient cost for the year post-diagnosis was $5171. Patients whose care deviated from the guidelines had a median cost of $7421. Additionally, both overtreatment and undertreatment as defined by the guidelines, resulted in higher patient costs.

According to the study, this increase in patient costs was seen for both overall and health care service-stratified costs, including outpatient, physician visit/carrier, and Medicare Part D costs.

The study also showed that the highest patient cost responsibility was associated with the nonapproved use of bevacizumab, translating to both an increased patient cost responsibility of approximately 12,000 in the first year after diagnosis and a 40% increased hazard of mortality.

“This example represents a cautionary tale for physicians who add novel agents without proven benefit to treatment regimens, potentially incurring substantial patient costs, and also highlights the fact that guidelines may change over time,” the study authors wrote.

As such, they noted that in formulating novel drugs or treatment guidelines, more emphasis should be placed on patient-centered outcomes, including decreased financial burden, prolonged over survival, and quality of life.

“The observation that out-of-pocket costs may be greater for guideline discordant care is important for both patients and physicians to understand, especially when many guideline discordant treatments may not improve clinical outcomes,” Matthew P. Goetz, MD, Mayo Clinic Cancer Center, member of the NCCN Guidelines Panel for Breast Cancer, said in a statement. “Clinical trials should be prioritized as a way to offer patients access to new drugs/treatments that might not otherwise be available to them, while limiting out-of-pocket expenses.”


Williams CP, Azuero A, Kenzik KM, et al. Guideline discordance and patient cost responsibility in Medicare beneficiaries with metastatic breast cancer. Journal of the National Comprehensive Cancer Network. 2019.

Following NCCN Guidelines for Metastatic Breast Cancer Results in Lower Costs for Patients, According to New Study [news release]. NCCN’s website. Accessed October 10, 2019.

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