PD 02 - Palliative 1 - Poster Discussion
1016 - Variation in Use of Palliative Radiation in Lung Cancer Patients With Bone Metastases by Health Care Market
Sunday, October 21
1:57 PM - 2:03 PM
Location: Room 217 C/D
Aileen Chen, MD
Dana-Farber Cancer Institute
Dana-Farber Cancer Institute: Employee, Attending physician: Employee
Variation in Use of Palliative Radiation in Lung Cancer Patients With Bone Metastases by Health Care Market
A. B. Chen1, A. M. Cronin2, and D. Schrag2; 1Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 2Dana-Farber Cancer Institute, Boston, MA
Purpose/Objective(s): Palliative radiation therapy (PRT) is an effective option for relieving pain from bone metastases. Based on randomized studies suggesting equivalent pain relief from shorter courses of treatment, national guidelines advocate for shorter courses of PRT. Though these guidelines address how PRT should be given, they do not address when PRT should be considered. We sought to measure variation in the use of PRT among Medicare patients with bone metastases at diagnosis.
Materials/Methods: Using data from SEER-Medicare, we identified patients over age 65 diagnosed with metastatic non-small cell lung cancer (NSCLC) from 2010-2013 who had bone metastases at diagnosis. We calculated the proportion of patients who received PRT within one year of diagnosis by Health Service Area (HSA), representing a geographic health care market. HSAs with at least 20 patients diagnosed during the study period were included in the analysis. A multivariable generalized linear mixed model with logit link was used to identify associations between patient and HSA characteristics and likelihood of receipt of PRT.
Results: Among 20,517 patients diagnosed with metastatic NSCLC, 6,681 (33%) had bone metastases at diagnosis. Of these, 51% received PRT within the first year. Among 80 HSAs with at least 20 patients in the cohort, use of PRT ranged from 30% to 82% (median 51%, 33%-66% 5%ile-95%ile). Patient factors associated with PRT use included younger age group (overall p<.01), female gender (OR 1.3, p<.01), married status (OR 1.45, p<.01), and race (white vs black vs other, OR 1.0 vs 0.76 vs 0.92, overall p<.01). HSA factors associated with PRT use included greater per capita Medicare spending (OR 1.13/$1000, p<.01), median household income (OR 1.11/$1000, p<.01), and density of hospitals with pain and/or palliative care services (4th vs 1st quartile, OR 1.58, overall p<.01).
Conclusion: We identified substantial variation in the use and intensity of PRT among lung cancer patients with bone metastases. Patient living in HSAs with higher Medicare spending and greater financial and pain/palliative care resources were more likely to receive PRT. This suggests a potential opportunity to better optimize use of PRT.
Author Disclosure: A.B. Chen: None. A.M. Cronin: None.