October 9, 2013
Recommended Treatment Regimen For Bone Metastases Not Widely Used
Justin E. Bekelman, M.D., of the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues conducted a study to examine whether single-fraction radiation treatment, shown to be as effective as multiple-fraction treatment with less potential for harm, has been incorporated into routine clinical practice for Medicare beneficiaries with prostate cancer and at what cost savings. Single-fraction radiotherapy is where a large dose of radiation is given in one session; with multiple-fraction radiotherapy, radiation is delivered in smaller doses over a longer period of time.
"Palliative radiotherapy, comprising l or more fractions (i.e., treatments) of daily radiation, is the mainstay of treatment for painful bone metastases. In 2005, a U.S.-based randomized trial demonstrated no difference in pain relief between single- and multiple-fraction radiotherapy for uncomplicated bone metastases, confirming results from international trials," according to background information in the article appearing in the October 9 issue of JAMA.
Of 3,050 patients included in the study, 3.3 percent had single-fraction radiotherapy and 50.3 percent received more than 10 fractions. Average 45-day radiotherapy-related expenditures were a relative 62 percent lower for patients treated with single relative to multiple fractions ($1,873 for single vs. $4,967 for multiple fractions).
"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. 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. 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," the authors conclude.
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