Lumpectomy With Radiation Versus Mastectomy for Early-Stage Breast Cancer: Value-Based Treatment Considerations.

Breast cancer is the most common malignancy in women, and most patients will present with early- stage disease. Multiple clinical trials have established the oncologic equivalence of the various treatment options available to these patients; however, each treatment approach is associated with varying degrees of complication rates, costs, and patient satisfaction. Reconciling these factors to formulate the "best" treatment plan for each individual patient can be a challenge. For example, a given intervention may result in high patient satisfaction at the expense of increased cost and complications. Conversely, an intervention with a low cost and low complication rate may result in poor patient satisfaction. Thus, a value-based approach, which aims to offset these often-competing factors, can optimize patient outcomes while reducing overall costs. Ongoing efforts seek to accurately and comprehensively define value for early breast cancer treatment strategies in order to optimize healthcare resource allocation. Population-based studies using registry or private insurance data have shed light on the cost of primary oncologic interventions and secondary costs from managing complications. Patient satisfaction has been assessed with survey data, and continues to be a subject of ongoing investigation. In this article, the authors review some of the salient data that can be used as a starting point for discussing management principles in a way that optimizes value to the benefit of the patient and the larger healthcare system. A path forward that emphasizes leveraging research efforts to define value and engaging patients in value-based treatment decisions is proposed. [ABSTRACT FROM AUTHOR]