Fractionation of Palliative Radiation Therapy for Bone Metastases in Ontario: Do Practice Guidelines Guide Practice?

Are radiation oncologists following guidelines? An audit of practice in patients with uncomplicated bone metastases

“…We found that older age was correlated with higher rates of SFRT use, with greater use of MFRT (p = 0.042) in patients 70 years of age or younger. Several other studies have shown a similar correlation between age and choice of fractionation [14,[22][23][24][25][26][27]. We found too that performance status was a significant predictor for the choice of fractionation.…”

“…Cancer Care Ontario published guidelines that advocated for the use of SFRT in patients with uncomplicated bone metastases. Immediately following this publication, rates of SFRT prescriptions increased, but this was short-lived [22]. It remains to be seen if releasing provincial guidelines periodically can provide a long-term solution to increasing adherence to guidelines.…”

“…We found too that performance status was a significant predictor for the choice of fractionation. Others have also shown that poor patient prognosis is associated with higher rates of SFRT use, which leads one to believe that prognosis can affect treatment choice [16,[22][23][24][25][26]28]. Other factors reported to be associated with SFRT use include radiation to sites other than the spine and lung or prostate primaries [14].…”

Breast cancer fractionation patterns: Why aren't they uniform, and should they be?

“…Finally, one institution started at a little more than 60% in 2009, and after a modest increase, the rate began declining in 2011, reaching about 53% in 2015. Indeed, similar institutional variation was found in a study of the use of single‐fraction palliation of bone metastases in Ontario, with the promulgation of provincial guidelines having only a very limited and transient impact …”

Use of Low-Value Radiotherapy Practices in Canada: An Analysis of Provincial Cancer Registry Data

“…The findings suggest that practice patterns vary considerably from province to province. That variation could be a result of differences in culture and clinical practice between cancer centres 19,20 . Factors influencing practice patterns include physician education, attitudes, and preferences; patient choice or preference; tumour and institutional factors; local treatment capacity; and distance from the radiation treatment centre 15,21,22 .…”