Prostate cancer patients receiving excessive palliative radiotherapy

Although the Choosing Wisely campaign argues only one radiation treatment, or fraction, is needed to control bone pain in the palliative treatment of metastatic prostate cancer, half of patients received more than 10 fractions, according to a research letter published Oct. 9 in the Journal of the American Medical Association.

“Despite evidence demonstrating comparable pain relief for single-fraction treatment, only 3.3 percent of Medicare beneficiaries with bone metastases from prostate cancer received single-fraction treatment,” wrote Justin E. Bekelman, MD, of the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.

Tapping into the Surveillance, Epidemiology and End Results-Medicare database, the authors identified 3,050 prostate cancer patients with bone metastases, median age 78 years, who underwent radiotherapy from Jan. 1, 2006, through Dec. 31, 2009. In addition to tracking the number of radiotherapy fractions, Bekelman and colleagues also looked at the overall difference in expenditures between single- and multi-fraction treatments.

Results showed that 50.3 percent of patients received more than 10 fractions. When analysis was restricted to patients without prior complicating events, the rate of single-fraction radiotherapy remained low at 3.8 percent.

Patients in the single-fraction treatment group had an unadjusted median survival of five months compared with nearly one year for the multi-fraction group.

“Patients who received single-fraction radiotherapy had poorer prognoses, perhaps reflecting the perception that single-fraction treatment should be reserved for patients with limited life expectancy or poor performance status,” wrote Bekelman and colleagues. “However, single-fraction treatment has substantial benefits for patient-centric palliative care, including greater quality of life and convenience, reduced travel time, and lower treatment costs.”

Mean 45-day radiotherapy-related expenditures were $1,873 for single and $4,967 for multiple fractions. Overall healthcare expenditures over the same time period were actually higher for the single-fraction group, reflecting the fact these patients were closer to death and using other medical services.