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

Tran, Kim; Rahal, Rami; Brundage, Michael; Fung, Sharon; Louzado, C.; Milosevic, Michael; Xu, Julie; Bryant, Heather

doi:10.3747/co.23.3359

Cited by 15 publications

(14 citation statements)

References 25 publications

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“…Within each country, there is also large variation in HFRT use between geographical regions and institutions. Data from Canada in 2013 showed that the use of HFRT in 2013 ranged from 43% to 94% across six provincial cancer registries, 20 and in a separate Ontario study, the use of HFRT varies from 32% to 87% between institutions 8 . Using the MROCQ data, Jagsi et al reported that the use of HFRT between 2011 and 2013 ranged from 2% to 80% across 13 radiation oncology departments 21 .…”

Section: Discussionmentioning

confidence: 99%

Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

et al. 2021

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Introduction To evaluate the adoption of hypofractionated radiotherapy (HFRT) for breast cancer (BC) in Victoria, Australia. Methods This is a population‐based cohort of women with BC who had breast RT as captured in the Victorian Radiotherapy Minimum Data Set between 2012 and 2017. We defined HFRT as < 25 fractions of RT. The pattern of HFRT use over time was evaluated with the Cochrane–Armitage test for trend. Factors associated with HFRT were identified using multivariable logistic regression. Results 12,717 women were included in the study. Overall, 6,653 (52%) patients had HFRT. HFRT use increased from 35% in 2012 to 66% in 2017 (P‐trend < 0.001). Older women were more likely to have HFRT (74% for women aged ≥ 70 years vs. 27% for women aged < 50 years; P < 0.001). Women who had nodal irradiation were less likely to have HFRT compared with those who did not (13% vs. 57%; P < 0.001). HFRT use was more common in public than private institutions (57% vs. 46%, P < 0.001), and in metropolitan than regional centres (54% vs. 46%, P < 0.001). In multivariable analyses, the progressive increase in HFRT use over time was independent of other covariates – women treated in 2017 were 7.3 times (95% CI = 6.3–8.6, P < 0.001) more likely to be treated with HFRT than in 2012. Age at RT, nodal irradiation, area of residence and institutional type and locations were all independently associated with HFRT use. Conclusion This large Australian contemporary population‐based study demonstrates increasing use of HFRT for BC. However, large sociodemographic and institutional provider‐related variations in practice still exist.

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Section: Discussionmentioning

confidence: 99%

Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

et al. 2021

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“…One study reported that SFRT was the most commonly used treatment regimen in Canada for bone metastases, although prescribed only 50% of the time [34]. This study also showed that the use of SFRT varied within Canada, ranging from 31 to 60%, depending on the province [34].…”

Section: Discussionmentioning

confidence: 61%

“…Radiation oncologists employed by academic centers, publicly funded centers, and those paid on a fee-for-service basis, as in Canada, were more likely to prescribe SFRT [33]. One study reported that SFRT was the most commonly used treatment regimen in Canada for bone metastases, although prescribed only 50% of the time [34]. This study also showed that the use of SFRT varied within Canada, ranging from 31 to 60%, depending on the province [34].…”

Section: Discussionmentioning

confidence: 73%

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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“…In a registry-based Canadian study, Ashworth et al [25] reported that SFRT use was 42% between 1984 and 2012. Data from provincial cancer registries indicated that across five provinces, 50% of patients receiving PRT for bone metastases were prescribed SFRT in 2013 [26]. Similarly, Olson et al [27] reported SFRT use of 49% between 2007 and 2011 in a population-based study in British Columbia.…”

Section: Bone Metastasesmentioning

confidence: 98%

Health Economic and Health Service Issues of Palliative Radiotherapy

2020

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

Abstract: Background As part of Choosing Wisely Canada (a national campaign to encourage patient-provider conversations

Cited by 15 publications

References 25 publications

Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

Choosing Wisely in radiation therapy for breast cancer: Time lag in adoption of hypofractionated radiation therapy in Victoria

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

Health Economic and Health Service Issues of Palliative Radiotherapy

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