New Breast Cancer Radiation Program in Kentucky Offers Same Care in Fewer Visits
When Brenda Bradley was diagnosed with breast cancer in 2010, she had no idea she would soon become one of the first American women to undergo a radically different approach to radiation treatment.
Bradley lives in the Hardin County town of Stephensburg with her husband, Tony. After Brenda received a lumpectomy, she and Tony discussed radiation treatment options with Dr. Anthony Dragun at the James Graham Brown Cancer Center in Louisville.
“And he asked would we be willing to become part of a study," recalls Brenda. "And we talked about it and went back and said ‘absolutely.’”
The program Dr. Dragun was proposing would drastically cut down on the traveling time and number of radiation sessions Brenda Bradley would endure. Instead of driving from Stephensburg to Louisville five days a week for up to seven weeks, Dr. Dragun told Brenda she could instead receive radiation once a week for five weeks.
“And he got us from 30 or 35 treatments to five. And we’ve never had a reason to look back. It worked so well, it was unbelievable,” the Hardin County native says.
The once-a-week approach to radiation was originated in Canada and Great Britain. In an effort to lower health care costs, doctors in those countries set out to see if they could treat breast cancer patients in fewer visits. British doctors eventually pioneered the practice of giving certain breast cancer patients once-a-week doses of radiation, instead of the customary schedule of five doses per week.
Dr. Dragun began wondering if the practice would work in Kentucky. He looked in the Kentucky Cancer Registry for every case in the previous 15 years involving a patient who, like Brenda Bradley, received a lumpectomy following a diagnosis of early-stage breast cancer.
“And how many of them actually followed through with radiation. We found that over that period of time there were better years, and there were worse years, but on average the rate was about two-thirds. So about one-third of the patients were just falling through the cracks,” says Dr. Dragun.
Dr. Dragun thought at least some of the women who didn’t follow up with radiation treatment might have done so if the one-treatment-a-week option had been available. The prospect of driving back and forth to Louisville Monday through Friday for up to seven weeks is a significant hurdle for many patients, especially for those in rural parts of the state. It’s also a burden for family members and friends who often have to take off of work to travel with the patient receiving radiation.
The patient also faces the physical and emotional toll of getting 25 to 35 radiation treatments in about a month-and-a-half. Brenda Bradley says if not for the one-treatment-a-week option, she likely wouldn’t have followed through with radiation.
“I don’t know that if at some time during that point we would have said ‘I’m done. I know we need 30 (treatments), but I just can’t do any more.’ But with the new treatment there was no sickness, no burning of the skin, no peeling,” she says.
Dr. Dragun says Brenda’s results are consistent with what he has seen so far with other patients getting radiation treatment once a week.
The new method is a trade-off. When a breast cancer patient receives radiation once a week, she’s getting a larger dose of radiation that day than she would receive in a given day under the old model. On the other hand, the overall weekly dosage of radiation is typically 40 percent less under the one-day-a-week treatment schedule.
“When you trade delivering the larger dose per day, but you shorten the overall course, you don’t have to deliver as high of a dose to be biologically equivalent,” says Dr. Dragun. "So women tend to have a lesser degree and severity of skin side effects.”
Dr. Dragun will soon treat the 100th patient using the once-a-week radiation schedule. In addition to women from the Louisville-Jefferson County area, Dr. Dragun says patients have come from as far east as Hazard, Ky., as well as Bowling Green, Cecilia, Ft. Knox, Leitchfield, Owensboro, and Radcliff.
Sitting in her Hardin County home next to Tony, her husband of 47 years, Brenda Bradley says she often thinks about the British and Canadian patients and doctors who pioneered the once-a-week approach to breast cancer radiation. She’s proud to have done something that could help benefit future cancer patients in this country.
“You have to be willing to keep studying, and let them study you as you go through trials, so that they can help other people,” says Brenda.
“Dr. Dragun couldn’t have come to us with what he had if the people in the other countries hadn’t been willing to do it. And maybe they didn’t have that good of a success at first. But they studied it, and they improved, and now look what we’ve got.”