Reducing the Burden of Cancer Care


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. 

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.

One of the key problems identified 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. 

Medical teams, however, lacked the mathematical framework and the technology to permit instant planning. By applying operations research to the problem, sophisticated optimization modeling and computational techniques were devised to implement an intraoperative 3D treatment planning system.

Memorial Sloan-Kettering Cancer Center became the first to employ this new technology. The real-time intraoperative planning system eliminates pre-operation simulation and post-implant imaging analysis. Based on the range of costs of these procedures, conservative estimates predicted 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. In addition, 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.