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Radiation therapy: An integral part of cancer care

An overview of radiation oncology


Abigail T. Berman, MD, MSCE Medical Director, CVS Health


More than half of all patients who have cancer receive some form of radiation therapy as part of their treatment, either alone or in conjunction with other therapies such as chemotherapy, surgery, and immunotherapy.1

Like these other therapies, radiation treatment, when appropriate, is highly specialized and tailored to the unique needs of the individual patient. Thus, utilization management must be both comprehensive and individualized to ensure patients get appropriate treatment. It’s useful for plan sponsors to understand how radiation oncology works, so that they can make informed choices in implementing the right utilization management solution.


How radiation oncology works to treat cancer

Put simply, radiation therapy uses high doses of radiation – much higher doses than those used in services such as x-rays – to kill cancer cells and shrink tumors. There are two basic types:

  • External beam radiation uses a machine that’s outside of the body to aim a beam of radiation at the part of the body that needs treatment. This is the most common type of radiation therapy.2
  • Internal radiation (brachytherapy) puts the source of radiation inside the body. This can be accomplished with seeds, needles, or catheters; at either a low dose rate (LDR) or high dose rate (HDR).

Radiation therapy requires high-tech equipment, specialized safety standards and protocols, and a highly trained care team.


Determining appropriate treatment

Clinically appropriate radiation therapy depends on a number of factors, including the type and location of the cancer, the size of the tumor, and the patient’s general health and medical history.

Radiation therapy doesn’t kill cancer cells right away. It can take days or weeks of therapy, and cancer cells may continue to shrink after therapy ends. The timing of radiation therapy depends on the goals of its use. For example, if radiation therapy is done in conjunction with surgery, it may be used before the surgery to shrink a tumor and make it easier to remove, during surgery to directly target the cancer without compromising healthy tissues, or after surgery to kill remaining cancer cells.

While radiation therapy often aims to eradicate cancer, it also sometimes is used palliatively. It may be used to shrink tumors or slow their growth to reduce pain or other problems caused by the cancer and improve quality of life for someone whose cancer may not be curable.


Risks and limitations of radiation oncology

Because radiation therapy uses high doses of radiation, attention must be paid to avoid significant risks and side effects. Radiation kills healthy cells in addition to cancerous cells. Side effects vary depending on which cells are affected and may include fatigue, hair loss, skin changes, mouth sores, nausea and vomiting, memory problems, sexual and fertility problems, and more.3 There are also lifetime limits on the amount of radiation a person can safely receive.

A key way to mitigate risks and to optimize therapy is to provide the most effective amount and type of radiation for a given situation. Treatment should be precise and align with current evidence-based standards of care, such as those from the American Society for Radiation Oncology and the National Comprehensive Cancer Network. Aligning with standards helps control costs, too.


The future of radiation oncology

Oncology is a continuously evolving field of medicine, with newer, more targeted therapies and clinical breakthroughs on the horizon. Radiation oncology is no exception. Researchers are working toward new ways of optimizing the effectiveness of radiation therapy, experimenting with different modalities of radiation, and fine-tuning ways radiation can work together with other types of cancer therapies to improve outcomes while minimizing toxicity.4


As radiation therapies evolve, so must treatment guidelines to help ensure that patients are getting clinically appropriate treatments that reflect the latest dynamic of care. Payors have an opportunity to help promote treatment that delivers on the latest evidence-based science, without compromising outcomes.


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