Physicians have not adopted single-fraction radiotherapy into routine practice for uncomplicated bone metastases of prostate cancer, as has been recommended, according to a report in the Oct. 9 issue of JAMA.
In a Research Letter to the editor, investigators reported that 3% of a series of 3,050 patients eligible for single-fraction palliative radiotherapy received it, even though this approach yields pain relief for bone metastases that is comparable to that of multiple-fraction radiotherapy.
Palliative radiotherapy, with either one or multiple fractions given daily, is the mainstay of treatment for painful bone metastases. Several trials have demonstrated that single-fraction and multiple-fraction approaches deliver the same pain relief, and single-fraction radiotherapy is significantly less expensive, said Dr. Justin E. Bekelman of the department of radiation oncology, University of Pennsylvania, Philadelphia, and his associates.
In addition, single-fraction radiotherapy has other patient-centric benefits, including improved quality of life, greater convenience, and reduced travel time. It is advocated over multiple-fraction radiotherapy by the Choosing Wisely campaign, they noted.
Dr. Bekelman and his colleagues analyzed information from the Surveillance, Epidemiology, and End Results database to assess whether single-fraction radiotherapy has been incorporated into routine clinical practice as recommended. They reviewed reimbursement records for Medicare beneficiaries with prostate cancer who were treated during a 3-year period.
The median patient age was 78 years, and 82% had two or more comorbid illnesses.
Of these patients, 3.3% received single-fraction radiotherapy, while the rest received multiple-fraction radiotherapy. Half of the patients received 10 or more fractions per day, the investigators said (JAMA 2013;310:1501-2).
In a sensitivity analysis restricted to the 2,028 patients who had no previous complicating events, 3.8% received single-fraction radiotherapy, confirming the results of the primary analysis.
The mean radiotherapy-related expenditures were 62% lower for patients who received single-fraction radiotherapy ($1,873), compared with those for patients who received multiple-fraction radiotherapy ($4,967).
This study was supported by the National Cancer Institute, the American Cancer Society, and the Leonard Davis Institute for Health Economics. No relevant financial conflicts of interest were reported.