Use of Radiation Therapy in the Last 30 Days of Life Among a Large Population-Based Cohort of Elderly Patients in the United States

Abstract

A B S T R A C T Purpose:Our goal was to evaluate use and associated costs of radiation therapy (RT) in the last month of life among those dying of cancer. Methods:We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare linked databases to analyze claims data for 202,299 patients dying as a result of lung, breast, prostate, colorectal, and pancreas cancers from 2000 to 2007. Logistic regression modeling was used to conduct adjusted analyses of potential impacts of demographic, health services, and treatment-related variables on receipt of RT and treatment with greater than 10 days of RT. Costs were calculated in 2009 dollars. Results:Among the 15,287 patients (7.6%) who received RT in the last month of life, its use was associated with nonclinical factors such as race, gender, income, and hospice care. Of these patients, 2,721 (17.8%) received more than 10 days of treatment. Nonclinical factors that were associated with greater likelihood of receiving more than 10 days of RT in the last 30 days of life included: non-Hispanic white race, no receipt of hospice care, and treatment in a freestanding, versus a hospital-associated facility. Hospice care was associated with 32% decrease in total costs of care in the last month of life among those receiving RT. Conclusion:Although utilization of RT overall was low, almost one in five of patients who received RT in their final 30 days of life spent more than 10 of those days receiving treatment. More research is needed into physician decision making regarding use of RT for patients with end-stage cancer.

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

“…This relationship has been documented internationally, suggesting that this phenomenon is not limited to US practice alone (32)(33)(34). The most salient explanation for the association of treating facility type and fractionation patterns is that radiation therapy may be overutilized at free-standing sites (35,36). We also demonstrated an association between private insurance and heightened use of MF-RT.…”

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

“…While palliative radiotherapy undoubtedly benefits patients with cancer in various stages of the disease, in terms of improving symptoms and potentially prolonging survival, its use during the last month of life has recently been questioned (5)(6)(7). Clinicians are often excessively optimistic when estimating the life expectancy of patients with advanced cancer, which may lead to treatment decisions that eventually become a burden for patients and caregivers, without improving the quality of life of the patients during the terminal phase of the disease (8,9).…”

Cancer-Related Therapies at the End of Life in Hospitalized Cancer Patients from Four Swiss Cantons: SAKK 89/09

“…Delivery of health care at the end of life of cancer patients has gained increasing attention during the last decade [1,2,3,4,5]. While the intensity of care in general seems to have increased over time [6,7,8], the appropriateness and quality of delivered care is increasingly discussed [9,10].…”