Use of Single- versus Multiple-Fraction Palliative Radiation Therapy for Bone Metastases: Population-Based Analysis of 16,898 Courses in a Canadian Province

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

“…That observation accords with results of other Canadian and European studies, but shows rates substantially higher than rates in the United States 20 . Studies conducted in the United States suggest that the use of single-fraction radiotherapy ranges from 3% to 14% 24 .…”

“…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 .…”

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

“…We observed that older patients, particularly those aged 80 years, patients with a greater degree of medical comorbidity, and those receiving radiation therapy to an extremity site were more likely to receive SF-RT. These findings reflect the role of proper patient selection but do not explain the discrepancy between US practice patterns and the trends seen in Canada and the United Kingdom (2,21).…”

“…These include, but certainly are not limited to, patient age, comorbidity, perceived prognosis and functional status, the site to be treated, and surrounding critical organs (2,21,28). We observed that older patients, particularly those aged 80 years, patients with a greater degree of medical comorbidity, and those receiving radiation therapy to an extremity site were more likely to receive SF-RT.…”

“…The annual incidence of bone metastases cases in the United States has been estimated at more than a quarter of a million cases per year (1). The economic burden imposed by osseous metastases is therefore immense, both to the medical system from direct costs of treatment, as well as the indirect expense borne by patients and their families (2). Given the ongoing push for cost containment in health care, the treatment of metastatic bone disease has the divergent potential to yield either impressive savings if practiced in a value-conscious fashion, or a marked cost excess if it is not.…”