Reducing the Burden of Cancer Care, Physically and Financially

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Fighting prostate cancer can be like going in the boxing ring with an opponent who weaves and jabs, leaving you fearful when he will strike his hardest blow. Physicians and patients begin by nervously reviewing test results to determine whether the disease, which every man will eventually contract if he lives into his nineties, should be treated at all. 

Once the decision is made and treatment is chosen, many patients with early stage prostate cancer decide to receive brachytherapy, a procedure for inserting tiny radioactive “seeds” into the diseased gland. 

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Brachytherapy can be effective, but its side effects often take a serious toll. What’s involved is this: If you insert the radioactive seeds into diseased tissue, you reduce the size of the cancer. If you mistakenly insert the seeds into healthy tissue in the prostate or nearby urethra and rectum, you interfere with sexual and bodily functions. In sum, you do less to cure the cancer and delay the patient’s eventual recovery, often for years.

Professor Eva K. Lee of the Georgia Institute of Technology studied the conundrum and determined that one of the key problems was in an important aspect of preplanning. Prior to the radiation dose, physicians and technicians draw a plan that involves careful targeting of a patient’s diseased tissue. Ideally, the plan should be made immediately before the procedure so that no changes take place in the prostate gland that would resulting in poor aiming of the radioactive pellets. 

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Medical teams, however, lacked the mathematical framework and the technology to permit instant planning. That’s where Prof. Lee began applying her expertise in operations research to the problem. She devised sophisticated optimization modeling and computational techniques to implement an intraoperative 3D treatment planning system.

Memorial Sloan-Kettering Cancer Center became a client willing to employ this new technology. Sloan-Kettering’s Dr. Marco Zaider, a medical physicist, became her partner at Sloan-Kettering. The real-time intraoperative planning system eliminates pre-operation simulation and post-implant imaging analysis. Based on the range of costs of these procedures, Prof. Lee estimates conservatively that their elimination nationwide could save $450 million a year for prostate cancer care alone. 

Resulting reduction of complications (45%–60%) due to plans that deliver less radiation to healthy structures improves the quality of life for patients and has a profound impact on the cost for interventions to manage side effects. Drs. Lee and Zaider also reported that the procedure uses significantly fewer seeds and needles compared with best-practice procedures. Thus, the procedure time is shortened and less invasive, and there is less blood loss. As a result, patients experience less pain and recover faster.

At Memorial Sloan-Kettering Cancer Center, marveled Dr. Zaider at the 2007 Edelman Gala, prostate cancer patients are thanking modern medicine for its advances. Little do they know that in this case an incisive operations research team made all the difference.