Increasing use of advanced radiation therapy technologies in the last 30 days of life among patients dying as a result of cancer in the United States

Abstract

Purpose: We sought to analyze trends in radiation therapy (RT) technology use and costs in the last 30 days of life for patients dying as a result of cancer.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare and Texas Cancer Registry-Medicare databases to analyze claims data for 13,488 patients dying as a result of lung, breast, prostate, colorectal, melanoma, and pancreas cancers from 2000 to 2009. Logistic regression modeling was used to conduct adjusted analyses regarding influence of demographic, clinical, and health services variables on receipt of types of RT. Costs were calculated in 2009 US dollars.

Results: The proportion of patients treated with two-dimensional RT decreased from 74.9% of those receiving RT in the last 30 days of life in 2000 to 32.7% in 2009 (P < .001). Those receiving three-dimensional RT increased from 27.2% in 2000 to 58.5% in 2009 (P < .001). The proportion of patients treated with intensity-modulated radiation therapy in the last 30 days of life increased from 0% in 2000 to 6.2% in 2009 (P < .001), and those undergoing stereotactic radiosurgery increased from 0% in 2000 to 5.0% in 2009 (P < .001). The adjusted mean costs of per-patient RT services delivered in the last 30 days of life were higher in the years 2007 to 2009.

Conclusion: Among patients receiving RT in the last month of life, there was a shift away from the simplest technique toward more advanced RT technologies. Studies are needed to ascertain whether these technology shifts improve palliative outcomes and quality of life for patients dying as a result of cancer who receive RT services.

Figure 1.

Use of types of radiation therapy (RT) technologies as a percent of the total number of courses of RT delivered to patients in the last 30 days of life from 2000 to 2009. 2DRT, two-dimensional RT; 3DRT, three-dimensional RT; IMRT, intensity-modulated RT; SRS, stereotactic radiosurgery.

Figure A1.

Aggregated and mean per-patient costs reimbursed by Medicare for radiation therapy (RT) services for patients beginning an RT course in the final 30 days of life from 2000 to 2009. USD, US dollars.