Patterns of care among patients receiving radiation therapy for bone metastases at a large academic institution

Abstract

Purpose: This study evaluates outcomes and patterns of care among patients receiving radiation therapy (RT) for bone metastases at a high-volume academic institution.

Methods and materials: Records of all patients whose final RT course was for bone metastases from April 2007 to July 2012 were identified from electronic medical records. Chart review yielded demographic and clinical data. Rates of complicated versus uncomplicated bone metastases were not analyzed.

Results: We identified 339 patients whose final RT course was for bone metastases. Of these, 52.2% were male; median age was 65 years old. The most common primary was non-small-cell lung cancer (29%). Most patients (83%) were prescribed ≤10 fractions; 8% received single-fraction RT. Most patients (52%) had a documented goals of care (GOC) discussion with their radiation oncologist; hospice referral rates were higher when patients had such discussions (66% with vs 50% without GOC discussion, P=.004). Median life expectancy after RT was 96 days. Median survival after RT was shorter based on inpatient as opposed to outpatient status at the time of consultation (35 vs 136 days, respectively, P<.001). Hospice referrals occurred for 56% of patients, with a median interval between completion of RT and hospice referral of 29 days and a median hospice stay of 22 days.

Conclusions: These data document excellent adherence to American Society for Radiation Oncolology Choosing Wisely recommendation to avoid routinely using >10 fractions of palliative RT for bone metastasis. Nonetheless, single-fraction RT remains relatively uncommon. Participating in GOC discussions with a radiation oncologist is associated with higher rates of hospice referral. Inpatient status at consultation is associated with short survival.

Fig. 1

Percent of palliative bone RT treatments by number of fractions prescribed. The most common fractionation scheme was 30 Gy in 10 fractions, comprising 51% of prescribed treatments.

Fig. 2

Kaplan-Meier death-censored survival after RT by admission status at the time of radiation oncology consultation for bone metastases. Survival curves demonstrate longer survival after RT among patients who were outpatients at the time of radiation oncology consultation (log-rank test, P<.001). Solid line = survival after RT among outpatients; dashed line = survival after RT among inpatients; crosses = censored cases.