The Oncotype DX Ductal Carcinoma In Situ (DCIS) score, which purportedly predicts the 10-year risk of recurrence for patient with DCIS, is not cost-effective for those treated with breast-conserving surgery, according to an article published in the Journal of Clinical Oncology.1
It is unknown whether adjuvant radiotherapy should be recommended for all patients with DCIS, though such therapy can reduce risk of recurrence by as much as half. Researchers simulated 10-year outcomes comparing 5 strategies, ranging from no testing and no radiotherapy for all patients to treating all patients with radiotherapy.
Cost-effectiveness was indeterminate among the strategies. Use of the Oncotype DX DCIS score, however, reduced the proportion of patients undergoing radiotherapy to cases of recurrence, reducing the number of radiotherapy-related toxicities.
The authors conclude that patient preferences must be taken into account when deciding whether to use the DCIS scoring system, or whether to use adjuvant radiotherapy without taking a score. The decision is, ultimately, subjective, and physicians should communicate the relevant costs and toxicity risks before taking a treatment or testing decision.
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Several study limitations are noted, including assumptions of the model used that oversimplify real-world clinical settings. The authors are, however, “confident” in the predictive outcomes.
- Raldow AC, Sher D, Chen AB, Recht A, Punglia RS. Cost effectiveness of the Oncotype DX DCIS score for guiding treatment of patients with ductal carcinoma in situ. J Clin Oncol. 2016 Sep 12. doi: 10.1200/JCO.2016.67.8532 [Epub ahead of print]