ArticleInternational journal of radiation oncology, biology, physics2018
Choosing Wisely at the End of Life: Use of Shorter Courses of Palliative Radiation Therapy for Bone Metastasis.
Article in International journal of radiation oncology, biology, physics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Results of a Randomized Phase 2 Trial of One Versus Two 8 Gy Fractions for Painful Bone Metastases.Journal of pain and symptom management · 2026Trial
- Prognosis of surgery and nomogram for patients with IIIA lung squamous cell carcinoma: a propensity score matched SEER database analysis.Journal of thoracic disease · 2025Article
- Identification of the optimal candidates to benefit from surgery and chemotherapy among elderly female breast cancer patients with bone metastases.Scientific reports · 2025Article
- Distant Multilevel Spinal Metastasis Secondary to Hypopharyngeal Squamous Cell Carcinoma.Cureus · 2024Article
- Development and validation of a nomogram for predicting the overall survival in non-small cell lung cancer patients with liver metastasis.Translational cancer research · 2023Article
- Survival benefit of resection surgery for lung adenocarcinoma with bone metastases and a post-operative prognosis nomogram establishment and validation.Journal of thoracic disease · 2022Article
- Listening to the Patient Voice Adds Value to Cancer Clinical Trials.Journal of the National Cancer Institute · 2022Article
- Nomograms predict survival benefits of radical prostatectomy and chemotherapy for prostate cancer with bone metastases: A SEER-based study.Frontiers in oncology · 2022Article
- Development and validation of a prognostic nomogram for bone metastasis from lung cancer: A large population-based study.Frontiers in oncology · 2022Article
- Article
- Trends in Radiation Therapy for Bone Metastases, 2015 to 2017: Choosing Wisely in the Era of Complex Radiation.International journal of radiation oncology, biology, physics · 2021Article
- A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management.Breast cancer research and treatment · 2021Article
- Incidence, prognosis and nomograms of breast cancer with bone metastases at initial diagnosis: a large population-based study.American journal of translational research · 2021Article
- Incidence, prognostic factors, and a nomogram of lung cancer with bone metastasis at initial diagnosis: a population-based study.Translational lung cancer research · 2019Article
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Authors and funding
7 authors.
Funding
Abstract
purposeAmerican Society for Radiation Choosing Wisely guidelines recommend ≤10 fractions of radiation therapy (RT) for bone metastasis, with consideration for 1 fraction in patients with a poor prognosis. The purpose of this analysis was to evaluate characteristic differences in guideline concordance to fractionation regimens in a modern cohort of older patients with a diagnosis of bone metastasis. METHODS AND MATERIALS: Medicare beneficiaries aged ≥65 years treated with RT for bone metastasis from 2012 to 2015 were identified. Guideline-concordant RT fractionation was defined in the entire cohort as ≤10 fractions. Utilization of 1 fraction versus ≥2 fractions was analyzed in deceased patients. Patient demographic, disease, and facility characteristics associated with shorter fractionation were analyzed.
resultsIn 569 patients treated with RT, the median age at diagnosis was 73 years. The most common cancer types were lung (37%), genitourinary (26%), breast (15%), and gastrointestinal (10%). Among all patients, 34%, 30%, and 36% received 1 fraction, 2 to 10 fractions, and ≥11 fractions, respectively. In comparison with receipt of 1 to 10 fractions, receipt of ≥11 fractions was associated with a $1467 increase in per-patient cost to Medicare during the calendar quarter of RT. Almost two-thirds of patients who died within 30 days of RT completion were treated with >1 fraction.
conclusionsAlthough guideline concordance was high overall, a large number of patients received longer courses of RT at the end of life. Strong consideration should be made for utilization of shorter courses, particularly in patients with a limited prognosis.
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