Title: Choosing Wisely at the end of life: use of shorter courses of palliative radiation for bone metastasis

Publication date: Available online 4 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Audrey S. Wallace, John B. Fiveash, Courtney P. Williams, Elizabeth Kvale, Maria Pisu, Bradford E. Jackson, Gabrielle B. Rocque
PurposeAmerican Society of Radiation Choosing Wisely guidelines recommend <10 fractions of radiation (RT) for bone metastasis, with consideration for 1 fraction in poor prognosis patients. The purpose of this analysis is to evaluate characteristic differences in guideline concordance to fractionation regimens in a modern cohort of older patients with diagnosis of bone metastasis.Methods and MaterialsMedicare beneficiaries 65 year of age or older treated with radiation for bone metastasis from 2012-2015 were identified. Guideline concordant radiation fractionation was defined in the entire cohort as 10 or fewer fractions. Utilization of 1 vs. 2 or more fractions was analyzed in deceased patients. Patient demographic, disease, and facility characteristics associated with shorter fractionation were analyzed.ResultsIn 569 patients treated with RT, median age at diagnosis was 73 years. The most common cancer types were lung (37%), genitourinary (26%), breast (15%), and gastrointestinal (10%). In all patients, 34%, 30%, and 36% received 1, 2-10, and 11+ fractions respectively. In comparison to 1-10 fractions, 11+ fractions were associated with $1467 increase cost to Medicare during the calendar quarter of RT per patient. Almost 2/3 of patients who died within 30 days of RT completion were treated with more than 1 fraction.ConclusionWhile guideline concordance was high overall, a large number of patients received longer courses of RT at the end of life. Strong consideration should be made for utilization of shorter courses particularly in patients with limited prognosis.

Teaser

This population based analysis shows increasing utilization of ASTRO guideline concordant fractionation for palliation of bone metastasis at 64% However, nearly 2/3 of patients received more than 1 fraction of RT in the last 30 days of life.


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