term sustainability of brachytherapy, it is paramount
that we create policies and regulations that ensure that
cancer patients receive the best possible care, including
consultation on the role of brachytherapy in their
treatment. Economic incentives cannot be allowed to
drive treatments offered to patients. As a field, we are
obligated to support the appropriate training of our
young practitioners to increase access to all appropriate
radiation oncology treatment options. We must
ensure that we are arming our patients with both the
knowledge and the power to make informed treatment
decisions.
Dr. Orio is the Vice Chair of Network Operations,
Assistant Professor and Director of Prostate Brachytherapy
in the Department of Radiation Oncology at Dana-
Farber/Brigham and Women’s Cancer Centers in Boston,
Massachusetts.
Dr. Viswanathan is a Professor and Interim Chair in
the Department of Radiation and Molecular Radiation
Sciences at Johns Hopkins.
She also serves as the Director
of Gynecologic Cancer Radiation and Director of the
National Capital Region.
ASTRO recognizes that brachytherapy, a highly cost-
effective radiation treatment, often faces regulatory
barriers that can limit patient access to care. ASTRO’s
advocacy teams commit significant resources working
to combat the coverage and payment challenges facing
brachytherapy.
In February, ASTRO issued an update to its
brachytherapy model policy
—
one of five modality
-
specific model policies that provides recommendations
for medical insurance coverage. Please refer to the
ASTRO website (
)
to read the Brachytherapy Model Policy, which
reflects current evidence, such as clarification
confirming the inclusion of the brain in head and
neck cancers, as well as the addition of diagnosis codes
associated with medical necessity and a statement on
electronic brachytherapy. The Brachytherapy Model
Policy exhibits what ASTRO believes are the correct
coverage policies for brachytherapy and does not serve
as a clinical guideline.
ASTRO health policy leaders also met with
Medicare officials recently as part of an ongoing effort
to confront a gross undervaluation of brachytherapy
reimbursement in the hospital outpatient setting.
ASTRO is asking the Centers for Medicare and
Medicaid Services to dramatically revise how they
pay for brachytherapy, specifically noting how
brachytherapy for cervical cancer is often reimbursed
at a level $16,000 below cost.
In addition, ASTRO successfully advocated for the
Nuclear Regulatory Commission to reform the way
it defines medical events for prostate brachytherapy,
which had been contributing to a chilling effect
among practitioners. Early in 2019, the Commission
published a new rule changing the definition to one
based on activity, rather than dose.
