Impact of Using Audit Data to Improve the Evidence-Based Use of Single-Fraction Radiation Therapy for Bone Metastases in British Columbia

Olson, Robert; Tiwana, Manpreet S.; Barnes, Mark; Cai, Eric; McGahan, Colleen; Roden, K.; Yurkowski, Emily; Gentles, Quinn; French, John; Halperin, Ross; Olivotto, Ivo A.

doi:10.1016/j.ijrobp.2015.06.044

Cited by 29 publications

(24 citation statements)

References 23 publications

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“…Another possible initiative to do so was studied in British Columbia, following a study that showed that SFRT was provincially underused [16]. Data from this study were then presented to radiation oncologists across the province at meetings and conferences, and the rates of SFRT prescriptions were measured following this intervention [39,40]. In fact, the authors found an increase in SFRT prescriptions by at least 10% [40].…”

Section: Discussionmentioning

confidence: 99%

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

Lalla

Fortin

Pembroke

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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Background: Best-practice guidelines recommend single-fraction (SFRT) instead of multi-fraction radiation therapy (MFRT) for uncomplicated symptomatic bone metastases. SFRT is comparable to MFRT in relieving pain, convenient for patients, and cost-effective. Patterns of practice in Canada reveal that SFRT is underused, with significant variability across the country. We audited SFRT use and studied factors that may influence treatment decisions at a large academic tertiary care center in Quebec, Canada. Methods: Patients who received radiotherapy for uncomplicated bone metastases between February 2014 and March 2015 were reviewed. Age, gender, primary histology, site of metastases and performance status were identified as potential factors affecting fractionation. These were explored by Fisher's test on univariate analysis and logistic regression for multivariate analysis. Retreatment rates were analyzed with cumulative incidence and compared with Gray's test. Results: 254 radiotherapy courses were administered to 165 patients, 85.4% of which were delivered using a single fraction of 8 Gy. Patients age less than 70 years and those with breast histology were more likely to receive MFRT (p = 0.04; p = 0.0046). Performance status (ECOG) was a significant predictor of fractionation because of high correlations between young age, breast histology, and ECOG status (p = 0.03). Follow-up was too short in 40% of patients to derive definitive conclusions on retreatment. Conclusions: In accordance with current guidelines, our audit confirms that use of SFRT in patients with uncomplicated bone metastases at our center is high. We identified that patient age, primary histology, and performance status influenced fractionation. Incorporation of this quality indicator into our performance dashboard will allow assessment of retreatment differences and other criteria that may also influence treatment choice.

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Section: Discussionmentioning

confidence: 99%

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

Lalla

Fortin

Pembroke

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

View full text Add to dashboard Cite

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“…Additionally, a recent SEER analysis reported a difference of $3094 (95% CI: $2107‐4081) between single fraction and 10 or longer fractionation schemes . There are estimates that an absolute increase of 10% use of single fraction palliative radiation therapy for metastatic prostate cancer could generate over $70 million per year in health cost savings …”

Section: Discussionmentioning

confidence: 99%

“…30 There are estimates that an absolute increase of 10% use of single fraction palliative radiation therapy for metastatic prostate cancer could generate over $70 million per year in health cost savings. 2,31,32 There are several limitations to this study, many of which are inherent to the NCDB and a retrospective analysis. The lack of clinical details regarding the specifics of each bone metastases is a major limitation.…”

Section: Short Course Long Course P-valuementioning

confidence: 99%

Palliative radiation therapy (RT) for prostate cancer patients with bone metastases at diagnosis: A hospital‐based analysis of patterns of care, RT fractionation scheme, and overall survival

et al. 2018

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Prostate cancer (PCa) is one of the most common malignancies associated with bone metastases, and palliative radiation therapy (RT) is an effective treatment option. A total of 2641 patients were identified with PCa and bone metastases at diagnosis from 2010 to 2014 in the NCDB. Fractionation scheme was designated as short course ([SC‐RT]: 8 Gy in 1 fraction and 20 Gy in 5 fractions) vs long course ([LC‐RT]: 30 Gy in 10 fractions and 37.5 Gy in 15 fractions). Patient characteristics were correlated with fractionation scheme using logistic regression. Overall survival was analyzed using the Kaplan‐Meier method, log‐rank test, Cox proportional hazards models, and propensity score‐matched analyses. A total of 2255 (85.4%) patients were included in the LC‐RT group and 386 (14.6%) patients in the SC‐RT group. SC‐RT was more common in patients over 75 years age (odds ratio [OR]: 1.70, 95% confidence interval [CI] 1.32‐2.20), treatment at an academic center (OR: 1.76, 1.20‐2.57), living greater than 15 miles distance to treatment facility (OR: 1.38, 1.05‐1.83), treatment to the rib (OR: 2.99, 1.36‐6.60), and in 2014 (OR: 1.73, 1.19‐2.51). RT to the spine was more commonly long course (P < .0001). In the propensity‐matched cohort, LC‐RT was associated with improved OS (P < .0001), but no OS difference was observed between 37.5 Gy and either 8 Gy in one fraction or 20 Gy in 5 fractions (P > .5). LC‐RT remains the most common treatment fractionation scheme for palliative bone metastases in PCa patients. Use of palliative SC‐RT is increasing, particularly in more recent years, for older patients, treatment at academic centers, and with increasing distance from a treatment center.

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“…11,12 These data, combined with audit data of prescribing practices and a knowledge translation strategy, led to increased use of single fraction radiotherapy across all six British Columbia cancer centers, saving money, increasing quality of life, and reducing wait times. 13,14 Not all provinces have mandated implementation of PRO measures and not all Canadian radiation oncology programs have the experience with PROs to know how best to use the information collected. As the majority of PRO work has been center-specific, there is an important need to look nationally at how best to improve alignment among these local level activities.…”

Section: Examples Of Pro Initiatives In Canadian Radiotherapy Programsmentioning

confidence: 99%

Improving patient outcomes and radiotherapy systems: A pan‐Canadian approach to patient‐reported outcome use

Caissie

Brown²,

Olson

et al. 2018

Medical Physics

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Standardized collection and use of clinical patient-reported outcomes (PRO) have potential to benefit the care of individual patients and improve radiotherapy system performance. Its centralized health-care system makes Canada a prime candidate to take a leader and collaborator role in international endeavors to promote expansion of patient-reported outcome collection and use in radiotherapy. The current review discusses the development of a pan-Canadian approach to PRO use, through a quality improvement initiative led by the Canadian Partnership for Quality Radiotherapy (CPQR), a unique partnership of Canadian radiotherapy professional organizations (Canadian Association of Radiation Oncology-CARO, Canadian Organization of Medical Physicists-COMP, and the Canadian Association of Medical Radiation Technologists-CAMRT).

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Impact of Using Audit Data to Improve the Evidence-Based Use of Single-Fraction Radiation Therapy for Bone Metastases in British Columbia

Cited by 29 publications

References 23 publications

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

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

Palliative radiation therapy (RT) for prostate cancer patients with bone metastases at diagnosis: A hospital‐based analysis of patterns of care, RT fractionation scheme, and overall survival

Improving patient outcomes and radiotherapy systems: A pan‐Canadian approach to patient‐reported outcome use

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