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Title: Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States

Abstract

Purpose: To characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions. Patients and Methods: The National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details. Results: We included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05). Conclusions: Single-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such thatmore » evidence-based and cost-conscious care becomes more commonplace.« less

Authors:
 [1];  [2]; ; ;  [1];  [2]
  1. Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)
  2. (United States)
Publication Date:
OSTI Identifier:
22458624
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 91; Journal Issue: 3; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPARATIVE EVALUATIONS; FRACTIONATED IRRADIATION; INSURANCE; LUNGS; MAMMARY GLANDS; METASTASES; NEOPLASMS; PATIENTS; PROSTATE; RADIOTHERAPY; SKELETON; USA

Citation Formats

Rutter, Charles E., E-mail: charles.rutter@yale.edu, Yale Cancer Center, New Haven, Connecticut, Yu, James B., Wilson, Lynn D., Park, Henry S., and Yale Cancer Center, New Haven, Connecticut. Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States. United States: N. p., 2015. Web. doi:10.1016/J.IJROBP.2014.10.045.
Rutter, Charles E., E-mail: charles.rutter@yale.edu, Yale Cancer Center, New Haven, Connecticut, Yu, James B., Wilson, Lynn D., Park, Henry S., & Yale Cancer Center, New Haven, Connecticut. Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States. United States. doi:10.1016/J.IJROBP.2014.10.045.
Rutter, Charles E., E-mail: charles.rutter@yale.edu, Yale Cancer Center, New Haven, Connecticut, Yu, James B., Wilson, Lynn D., Park, Henry S., and Yale Cancer Center, New Haven, Connecticut. Sun . "Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States". United States. doi:10.1016/J.IJROBP.2014.10.045.
@article{osti_22458624,
title = {Assessment of National Practice for Palliative Radiation Therapy for Bone Metastases Suggests Marked Underutilization of Single-Fraction Regimens in the United States},
author = {Rutter, Charles E., E-mail: charles.rutter@yale.edu and Yale Cancer Center, New Haven, Connecticut and Yu, James B. and Wilson, Lynn D. and Park, Henry S. and Yale Cancer Center, New Haven, Connecticut},
abstractNote = {Purpose: To characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions. Patients and Methods: The National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details. Results: We included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05). Conclusions: Single-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such that evidence-based and cost-conscious care becomes more commonplace.},
doi = {10.1016/J.IJROBP.2014.10.045},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 91,
place = {United States},
year = {Sun Mar 01 00:00:00 EST 2015},
month = {Sun Mar 01 00:00:00 EST 2015}
}