When it comes to using radiation to treat cancer patients dealing with the pain of tumors that have spread to their bones, a new report is saying that less is more.
In a study published in JAMA, researchers at the University of Pennsylvania found that patients with terminal cancer who receive a single session of radiotherapy get just as much pain relief as those who receive multiple treatments.
“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 lead author, Justin E. Bekelman, MD, an assistant professor of Radiation Oncology in Penn Medicine’s Abramson Cancer Center. Fraction refers to a session of radiation treatment.
“The fact is, this is a good treatment that’s better for patients. It’s effective, it’s more convenient, and better for their quality of life. Single-fraction treatment should be the standard of care.”
But despite the obvious advantages for patient comfort, convenience, and the associated cost savings, single-fraction treatment has yet to be adopted in routine practice.
In fact, more than 95 percent of advanced prostate cancer patients received multiple radiation treatments for pain control despite the mounting evidence pointing to the benefits of single treatments.
Bekelman and his colleagues examined at a group of 3,050 patients 65 years and older treated with radiotherapy for advanced prostate cancer and bone metastases. The patients were drawn from the national Surveillance, Epidemiology and End Results -Medicare database.
Only three percent of the patients received single-fraction treatment and nearly half had more than 10 treatments. The costs of those excessive treatments, researchers say, were substantial.
The average cost of radiotherapy for patients who received a single treatment was $1,873, as opposed to $4,967 for multiple fractions.
The call for single-fraction treatment for routine pain control continues to grow among professional societies, notes Bekelman, except in cases where complications require specialized therapy, such as spinal cord compression or broken bones caused by tumors.
And in about 10 percent of the cases, when the cancer has spread not only to the bones but also to the nearby soft tissue, a patient may need more than 10 treatments.
But instead, his research found 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.”
Bekelman speculates that a combination of factors probably contribute to the overuse of radiation.
Some doctors, he said, might worry about a recurrence after a single treatment, or the potential need for repeat radiation therapy later on.
Additionally, he noted, doctors get paid per treatment, so there is a potential financial motivation.