Cervical cancer cell targeted by radiation therapy with dissolving financial barriers

Brachytherapy vs. IMRT: Why Cervical Cancer Treatment Access Matters

Rhea Morgan in Health & Wellness August 2025 • 4 min read.

"Declining brachytherapy use in cervical cancer treatment: Understanding the factors and advocating for improved access."

Cervical cancer treatment has seen shifts in approaches, with brachytherapy, a highly effective local radiation therapy, being used less frequently in some regions. This trend raises concerns because brachytherapy significantly improves survival rates. Understanding why this decline is occurring is essential to ensure patients receive the best possible care.

Several factors contribute to the changing landscape of cervical cancer treatment. These include the way healthcare systems reimburse physicians, the financial incentives that can influence treatment choices, and the increasing adoption of newer technologies like Intensity Modulated Radiation Therapy (IMRT). Examining these elements helps to reveal the complexities affecting treatment decisions.

This article will delve into the financial and practical challenges associated with brachytherapy, explore how these challenges impact its use in treating cervical cancer, and discuss the importance of advocating for policies that support access to this life-saving treatment option.

The Economics of Cancer Care: How Reimbursement Impacts Treatment Choices

Cervical cancer cell targeted by radiation therapy with dissolving financial barriers

One significant factor influencing the use of brachytherapy is the reimbursement structure within healthcare. Brachytherapy often has lower relative value units per unit of time compared to IMRT. While the exact ratio can vary, the considerable time commitment required for brachytherapy is undeniable.

Relative value units directly affect physician compensation in many practices, potentially creating a disincentive to perform brachytherapy. Economic principles suggest that financial incentives influence behavior and choices, a concept applicable to healthcare decisions. Evidence indicates that the use of higher-reimbursement treatments is rapidly increasing in radiation oncology.

Financial Disincentives: Lower reimbursement rates for brachytherapy compared to IMRT can discourage its use.
Physician Compensation: Compensation models often prioritize procedures with higher relative value units.
Economic Impact: Financial incentives significantly influence treatment decisions in healthcare.

To illustrate, the increased use of IMRT for prostate cancer has been observed when urologists have ownership interests in self-referral centers. Conversely, brachytherapy rates for cervical cancer have declined as IMRT use as a boost has increased. These trends highlight how financial factors can steer treatment choices, sometimes at the expense of potentially more effective options like brachytherapy.

Advocating for Brachytherapy: Improving Access and Saving Lives

A survey by the Korean Radiation Oncology Group revealed that low reimbursement rates and high costs were primary reasons for not establishing or maintaining brachytherapy programs. The group recommended increasing medical fees for brachytherapy, a step that could significantly improve its accessibility.

Given the proven survival benefits of brachytherapy for cervical cancer, ASTRO's advocacy is crucial. By addressing financial disincentives and promoting fair reimbursement, we can improve access to this vital treatment and ultimately save lives.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/00006123-199905000-00065, Alternate LINK

Title: Comments

Subject: Neurology (clinical)

Journal: Neurosurgery

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Mina Foroohar, Bryce K.A. Weir

Published: 1999-05-01

Everything You Need To Know

What exactly is brachytherapy, and why is there concern about its decreasing use in treating cervical cancer?

Brachytherapy is a type of local radiation therapy that involves placing radioactive sources inside the body, close to the tumor. It's highly effective in treating cervical cancer. However, its use has been declining, which is concerning because it significantly improves survival rates. The decline seems to be due to several factors, including how healthcare systems reimburse physicians and the increasing use of newer technologies like Intensity Modulated Radiation Therapy (IMRT).

How does the way healthcare systems reimburse physicians affect the use of brachytherapy compared to other treatments like IMRT?

The reimbursement structure within healthcare seems to be a factor. Brachytherapy often has lower relative value units per unit of time compared to IMRT. This means that physicians may be compensated less for performing brachytherapy, even though it can be a more effective treatment option for some patients. This creates a financial disincentive that can influence treatment decisions.

What kind of financial incentives are at play that might discourage doctors from using brachytherapy, even if it's a good treatment option?

Financial incentives play a significant role in healthcare decisions. Compensation models often prioritize procedures with higher relative value units, which can discourage the use of brachytherapy. The increased use of IMRT for prostate cancer when urologists have ownership interests in self-referral centers exemplifies how financial factors can steer treatment choices. This may happen at the expense of potentially more effective options like brachytherapy.

What is being done to advocate for brachytherapy and improve access to this treatment for cervical cancer patients?

The American Society for Radiation Oncology (ASTRO) is actively involved in evaluating brachytherapy reimbursement through comprehensive reviews of costs and reimbursement structures. These efforts aim to address the financial barriers that limit the availability of brachytherapy, ensuring that patients have access to this life-saving treatment option. This involves advocating for policies that support brachytherapy and address financial disincentives.

What are the implications of the increasing use of IMRT in place of brachytherapy for cervical cancer, and how might financial incentives be influencing this shift?

While IMRT is a valuable radiation therapy technique, the trend of its increased adoption as a 'boost' while brachytherapy rates decline raises concerns about potentially compromising treatment efficacy for cervical cancer. IMRT's increasing use is influenced by factors such as reimbursement rates and financial incentives, which might overshadow clinical considerations. It's crucial to ensure treatment decisions are based on what's best for the patient's outcome, not just financial considerations. Further, the cost and effectiveness should be included in medical education.