Increasing Use of Technology With Palliative Radiation Therapy

Abstract

Purpose/Objective(s)Technology in radiation therapy (RT) has increased dramatically over the past decades. The purpose of this study was to define the patterns of care across the United States in patients with metastatic cancer treated with palliative intensity modulated radiation therapy (IMRT), and palliative stereotactic radiation therapy.Materials/MethodsThe Surveillance Epidemiology and End Results (SEER)-Medicare linked database was used to identify patients with metastatic breast, prostate, lung or colorectal cancer treated with radiation, diagnosed between 2000 and 2007, and followed through 2009. The receipt of palliative IMRT, and palliative stereotactic RT was determined from Medicare claims data. Multivariate logistic regression determined the predictors of palliative IMRT, and palliative stereotactic RT.ResultsA total of 25,888 patients treated with palliative RT were identified from the SEER-Medicare database. The use of palliative IMRT as a fraction of all palliative RT increased steadily over the study period, from 0% in 2000, to 6% in 2007. Among IMRT patients, only 26% had received a course of prior palliative "non-IMRT" radiation, the remainder received IMRT with their first course of radiation. The most common disease site treated with IMRT was prostate cancer (8.6% of all prostate palliative RT patients), followed by colorectal (4.0%), lung (3.5%), and breast (2.8%). Multivariate analysis revealed that significant predictors (p<0.05) of the use of palliative IMRT in addition to tumor site, included younger age (odds ratio [OR]=1.7), race (Asian [OR=1.8], or Hispanic [OR=1.9]), geography (South [OR=1.6], or West [OR=1.3]), and a higher density of radiation oncologists per square mile (OR=1.3). Palliative stereotactic RT use increased from 0.6% in 2000, to 5% in 2007. Among stereotactic RT patients, 66% had cranial-specific Medicare billing codes, and presumably received stereotactic RT treatment for brain metastases. The most commonly treated palliative RT disease site was lung cancer (3.9% of all lung palliative RT patients), followed by colorectal (3.2%), breast (1.8%), and prostate cancer (0.3%). Multivariate analysis revealed that significant predictors (p<0.05) of stereotactic RT in addition to tumor site, included younger age (OR=2.5), lower Charlson comorbidity score (OR=1.6), and location on the West coast (OR=1.3), whereas black patients were less likely to receive stereotactic RT (OR=0.45).ConclusionsThis study demonstrates increasing trends in the use of technology with palliative radiation therapy. While these advanced technologies have the ability to improve radiation delivery, they come at an increased cost, and may offer limited benefit over traditional forms of radiation in patients with a short life expectancy. Future research should consider the cost-effectiveness of advanced technology in palliative radiation therapy. Purpose/Objective(s)Technology in radiation therapy (RT) has increased dramatically over the past decades. The purpose of this study was to define the patterns of care across the United States in patients with metastatic cancer treated with palliative intensity modulated radiation therapy (IMRT), and palliative stereotactic radiation therapy. Technology in radiation therapy (RT) has increased dramatically over the past decades. The purpose of this study was to define the patterns of care across the United States in patients with metastatic cancer treated with palliative intensity modulated radiation therapy (IMRT), and palliative stereotactic radiation therapy. Materials/MethodsThe Surveillance Epidemiology and End Results (SEER)-Medicare linked database was used to identify patients with metastatic breast, prostate, lung or colorectal cancer treated with radiation, diagnosed between 2000 and 2007, and followed through 2009. The receipt of palliative IMRT, and palliative stereotactic RT was determined from Medicare claims data. Multivariate logistic regression determined the predictors of palliative IMRT, and palliative stereotactic RT. The Surveillance Epidemiology and End Results (SEER)-Medicare linked database was used to identify patients with metastatic breast, prostate, lung or colorectal cancer treated with radiation, diagnosed between 2000 and 2007, and followed through 2009. The receipt of palliative IMRT, and palliative stereotactic RT was determined from Medicare claims data. Multivariate logistic regression determined the predictors of palliative IMRT, and palliative stereotactic RT. ResultsA total of 25,888 patients treated with palliative RT were identified from the SEER-Medicare database. The use of palliative IMRT as a fraction of all palliative RT increased steadily over the study period, from 0% in 2000, to 6% in 2007. Among IMRT patients, only 26% had received a course of prior palliative "non-IMRT" radiation, the remainder received IMRT with their first course of radiation. The most common disease site treated with IMRT was prostate cancer (8.6% of all prostate palliative RT patients), followed by colorectal (4.0%), lung (3.5%), and breast (2.8%). Multivariate analysis revealed that significant predictors (p<0.05) of the use of palliative IMRT in addition to tumor site, included younger age (odds ratio [OR]=1.7), race (Asian [OR=1.8], or Hispanic [OR=1.9]), geography (South [OR=1.6], or West [OR=1.3]), and a higher density of radiation oncologists per square mile (OR=1.3). Palliative stereotactic RT use increased from 0.6% in 2000, to 5% in 2007. Among stereotactic RT patients, 66% had cranial-specific Medicare billing codes, and presumably received stereotactic RT treatment for brain metastases. The most commonly treated palliative RT disease site was lung cancer (3.9% of all lung palliative RT patients), followed by colorectal (3.2%), breast (1.8%), and prostate cancer (0.3%). Multivariate analysis revealed that significant predictors (p<0.05) of stereotactic RT in addition to tumor site, included younger age (OR=2.5), lower Charlson comorbidity score (OR=1.6), and location on the West coast (OR=1.3), whereas black patients were less likely to receive stereotactic RT (OR=0.45). A total of 25,888 patients treated with palliative RT were identified from the SEER-Medicare database. The use of palliative IMRT as a fraction of all palliative RT increased steadily over the study period, from 0% in 2000, to 6% in 2007. Among IMRT patients, only 26% had received a course of prior palliative "non-IMRT" radiation, the remainder received IMRT with their first course of radiation. The most common disease site treated with IMRT was prostate cancer (8.6% of all prostate palliative RT patients), followed by colorectal (4.0%), lung (3.5%), and breast (2.8%). Multivariate analysis revealed that significant predictors (p<0.05) of the use of palliative IMRT in addition to tumor site, included younger age (odds ratio [OR]=1.7), race (Asian [OR=1.8], or Hispanic [OR=1.9]), geography (South [OR=1.6], or West [OR=1.3]), and a higher density of radiation oncologists per square mile (OR=1.3). Palliative stereotactic RT use increased from 0.6% in 2000, to 5% in 2007. Among stereotactic RT patients, 66% had cranial-specific Medicare billing codes, and presumably received stereotactic RT treatment for brain metastases. The most commonly treated palliative RT disease site was lung cancer (3.9% of all lung palliative RT patients), followed by colorectal (3.2%), breast (1.8%), and prostate cancer (0.3%). Multivariate analysis revealed that significant predictors (p<0.05) of stereotactic RT in addition to tumor site, included younger age (OR=2.5), lower Charlson comorbidity score (OR=1.6), and location on the West coast (OR=1.3), whereas black patients were less likely to receive stereotactic RT (OR=0.45). ConclusionsThis study demonstrates increasing trends in the use of technology with palliative radiation therapy. While these advanced technologies have the ability to improve radiation delivery, they come at an increased cost, and may offer limited benefit over traditional forms of radiation in patients with a short life expectancy. Future research should consider the cost-effectiveness of advanced technology in palliative radiation therapy. This study demonstrates increasing trends in the use of technology with palliative radiation therapy. While these advanced technologies have the ability to improve radiation delivery, they come at an increased cost, and may offer limited benefit over traditional forms of radiation in patients with a short life expectancy. Future research should consider the cost-effectiveness of advanced technology in palliative radiation therapy.