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Single-fraction radiation rarely used for patients with advanced prostate cancer
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Only 3.3% of Medicare beneficiaries with prostate cancer that metastasized to their bones received single-fraction radiation treatment, despite evidence that the regimen is comparably effective to and less expensive than multiple-fraction radiotherapy, study results showed.
Results of a randomized trial published in 2005 showed no difference in pain relief between single- and multiple-fraction radiotherapy for uncomplicated bone metastases, confirming results from prior international trials.
Since then, the Choosing Wisely campaign — an initiative designed to encourage physicians and patients to choose evidence-based care that is necessary and does not cause more harm than good — has advocated single-fraction treatment for bone metastases.
In the current study, researchers set out to assess the prevalence and cost of single-fraction treatment among Medicare beneficiaries.
The investigators used the SEER-Medicare Linked database to identify 3,050 patients aged 65 years and older with prostate cancer and bone metastases who underwent radiotherapy from 2006 through 2009.
Researchers obtained information on the initial outpatient course of radiotherapy following index diagnosis of bone metastasis, and they determined the dates and number of radiotherapy fractions based on Medicare claims for radiation delivery.
Results showed 3.3% (95% CI, 2.7-3.9) of patients received single-fraction radiotherapy and 50.3% (95% CI, 48.5-52.1) received more than 10 fractions.
Results of a sensitivity analysis that included 2,028 patients without previous conditions suggested 3.8% (95% CI, 3.0-4.6) underwent single-fraction radiotherapy.
Unadjusted median survival after the index radiotherapy course was 11.9 months in the multiple-fraction group (95% CI, 11.2-12.7) compared with 5 months in the single-fraction group (95% CI, 3.6-10.5).
More than half (51.7%) of patients who survived more than 6 months received subsequent radiation treatment, although it did not significantly extend survival.
Mean 45-day radiotherapy-associated expenditures were lower for patients who underwent single-fraction treatment ($1,873 vs. $4,967; P<.001).
Mean 45-day overall health care expenditures were higher among those treated with single-fraction treatment ($13,112 vs. $11,702), but researchers noted those patients were closer to death and were using other medical services.
“Patients who received single-fraction radiotherapy had poorer prognoses, perhaps reflecting the perception that single-fraction treatment should be reserved for patients with limited life expectancy or poor performance status,” the researchers wrote. “However, single-fraction treatment has substantial benefits for patient-centric palliative care, including greater quality of life and convenience, reduced travel time and lower treatment costs.”
Disclosure: The study was supported by grants from NCI and the American Cancer Society, as well as funding from the Leonard Davis Institute for Health Economics. The researchers report honoraria from ASCO, grant support from the Institute for Health Technology Studies and travel support from the Radiation Oncology Institute.
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