Palliative Radiation Overused in Patients with Metastatic NSCLC
(ChemotherapyAdvisor) – A substantial proportion of patients with metastatic non-small cell lung cancer (NSCLC) treated with palliative radiation therapy (RT) to the bone or chest receive higher doses and more fractions than clinical trial data supports, results of a Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study reported in the Journal of Clinical Oncology published online January 7, 2013.
“Palliative RT is frequently used in patients with metastatic NSCLC and has clearly demonstrated ability to improve quality of life in those patients,” noted Aileen B. Chen, MD, MPP, of the Dana-Farber Cancer Institute, Boston, MA, and colleagues. “However, treatment can incur significant time and monetary costs for patients with limited life expectancy.”
Approximately half of patients with NSCLC have metastatic disease at diagnosis and for the majority, single-fraction or short-course palliative RT is sufficient, according to randomized data. To investigate population-based patterns in the use of palliative RT among patients with metastatic NSCLC, the investigators identified those diagnosed with lung cancer from 2003 to 2005 at participating institutions.
Of these 1,574 patients, 780 (50%) had received at least one course of RT, 21% to the chest and 12% to the bone. Median age was 68 years and 35% were female. After a diagnosis of metastasis, 51% received at least one course of chemotherapy, 6% had surgery directed at the primary tumor, and 6% had surgery to a metastatic site. Median survival was 4.7 months.
“Use of palliative RT was associated with younger age at diagnosis and receipt of chemotherapy and surgery to metastatic sites,” Dr. Chen reported. “Among patients receiving palliative bone RT, only 6% received single-fraction treatment. Among patients receiving palliative chest RT, 42% received more than 20 fractions.”
They found that patients treated in an integrated health system network—a health maintenance organization or the Veterans Administration—were more likely to receive lower doses and fewer fractions to the bone and chest.
These results suggest that “provider characteristics, organizational structures and processes, and/or financial incentives may influence clinical practice,” the authors concluded. “However, further study is necessary to clarify the reasons for the extent of overly intensive care and to develop strategies for bringing evidence and practice into better alignment.”