Adherence to the American Society of Radiation Oncology Choosing Wisely Campaign Recommendations for Treatment of Bone Metastasis: Analysis of Medicare Data at 12 Centers in the Southeast US (SA527C)

Abstract

•Understand adherence to Choosing Wisely guidelines from a radiation oncology perspective.•Appreciate the impact of patient, practitioner, and system on choice of duration of treatment. The American Society of Therapeutic Radiation Oncology (ASTRO) Choosing Wisely (CW) campaign recommends avoidance of extended fractionation (>10 treatments) for palliation of bone metastasis with radiation therapy (RT). The purpose of this study is to analyze palliative fractionation schemes in a cohort of Medicare patients. Data were for Medicare patients > 65 with bone metastasis diagnosis from 12 cancer community networks affiliated with an academic center in Alabama, Mississippi, Georgia, Tennessee, and Florida. Stage IV cancer patients treated with radiation for bone metastasis from Quarter 1, 2012 to Quarter 1, 2015 were eligible and identified using ICD-9(198.5) and CPT/HCPCS codes. Adherence was measured by treatment duration ≤ 14 vs >14 calendar days. 2194 patients with bone metastasis were identified, 427 (19.5%) of which were treated with RT: 16.6% (2012), 37.5% (2013), 27.4% (2014), 18.5% (2015). Median age at diagnosis was 69.2 (IQR 9.0), and 1928 (87.8%) patients were Caucasian. In the 427 patients treated with RT, 25.8%, 37.0%, and 33.0% were treated in 2012, 2013, and 2014. The top 4 primary sites were: genitourinary (22.7%), breast (20.4%), gastrointestinal (15.7%), and lung (10.8%). Overall guideline adherence was 65.1%: 1 fraction in 33.3%, <14 calendar days in 31.9%, and > 14 calendar days in 34.9%. Average adherence by upper, middle, and lower tertile of sites was 52.0%, 64.5%, 71.5%. Adherence by primary cancer type was similar: breast (58.6%), lung (65.2%), gastrointestinal (67.2), and genitourinary (72.5%). In patients treated < 14 days, 4% were treated with either 1 or 2-5 fractions of stereotactic body radiotherapy. While compliance was high overall with ASTRO CW recommendations, there remained a significant portion (36%) of patients who received a prolonged course of palliative radiation.