October 10, 2013 — Medical evidence over the past decade has demonstrated that patients with terminal cancer who receive a single session of radiotherapy get just as much pain relief as those who receive multiple treatments. But despite its obvious advantages for patient comfort and convenience (and cost savings), this single-fraction treatment has yet to be adopted in routine practice, according to a study led by the Perelman School of Medicine at the University of Pennsylvania published in The Journal of the American Medical Association (JAMA).
“Increased use of single fraction treatment would achieve the holy grail of health reform, which is real improvements in patient care at substantial cost savings,” said Justin Bekelman, M.D., assistant professor, Penn Medicine’s Abramson Cancer Center and lead author of the study. “Despite the evidence, single fraction treatment is used rarely and it’s reserved for patients with the poorest prognosis.”
Bekelman and his colleagues examined a group of 3,050 patients 65 years and older treated with radiotherapy for advanced prostate cancer and bone metastases. In the analysis of patients drawn from the national Surveillance, Epidemiology and End Results (SEER)-Medicare database, they found only 3 percent of patients studied received just single-fraction treatment, and nearly half the patients had more than 10 treatments. The costs of the excess treatments, the authors found, were substantial: mean 45-day radiotherapy-related expenditures were 62 percent lower for patients who received one treatment, at $1,873 for single versus $4,967 for multiple fractions.
Professional societies have recommended single-fraction treatment over multiple fractions for routine pain control except in cases with complications that require specialized therapy, such as spinal cord compression or broken bones caused by tumors.
Bekelman’s findings underscore the importance of efforts such as the Choosing Wisely campaign, which seeks to identify and promote medical practices that offer the highest value and best outcome for patients. Bekelman’s data shows that patients are routinely receiving extra radiation treatments that drive up health care costs without conferring additional benefits to patients.
“Whether you get more or less radiation for bone metastases has nothing to do with survival,” said Bekelman. “When clear and consistent evidence exists that supports single fraction treatment, we should proceed with the treatment that has equivalent pain control, is more convenient and gets patients out of treatment quicker.”
For more information: jama.jamanetwork.com, www.cancer.gov