1 The University of Texas MD Anderson Cancer Center, Houston, TX.
J Oncol Pract. 2019 Apr;15(4):e356-e368. doi: 10.1200/JOP.18.00588. Epub 2019 Mar 8.
To evaluate trends in fractionation and cost of radiation for bone metastasis during a time period of multiple national quality improvement initiatives that focused on reducing the number of fractions per radiation episode.
Using nationwide Medicare claims from 2011 to 2014, we identified radiation episodes for bone metastasis from prostate, lung, and breast cancer. Details regarding fractionation, radiation therapy (RT) modality, and sociodemographic characteristics were abstracted from claims. Time trends in use of 10 or fewer RT fractions per episode were evaluated using the Cochran-Armitage test. Total cost per episode was calculated from a payer's perspective and reported in 2017 dollars; time trends in cost were assessed using linear regression. Generalized linear models identified predictors of treatment with 10 or fewer fractions.
Of 51,533 episodes identified, 46,326 used 2D/3D RT, 3,199 used intensity-modulated RT, and 2,008 used stereotactic body RT. The proportion of 2D/3D RT episodes using 10 or fewer fractions increased from 65.5% to 79.7% ( P < .001), and mean total cost per episode decreased from $6,742 to $6,067 ( P < .001). Use of single-fraction radiation increased modestly for 2D/3D treatment (6.5% to 8.1%; P < .001). Predictors of 10 or fewer fractions included treatment in recent years, advanced age (≥ 85 years), and higher comorbidity score. Variation was noted based on geographic region and primary cancer.
During a period with quality initiatives launched by the American Society for Radiation Oncology, American Board of Internal Medicine, and National Quality Forum, use of 10 or fewer fractions for bone metastasis increased by 14.2%, but single-fraction regimens increased by only 1.6%, highlighting opportunities for quality improvement.
评估在多个国家质量改进计划期间，针对减少每次放射治疗的分割次数的重点，骨转移放射治疗的分割次数和成本趋势。
使用 2011 年至 2014 年全国性的医疗保险索赔数据，我们从前列腺癌、肺癌和乳腺癌中确定了骨转移的放射治疗病例。从索赔中提取了分割、放射治疗（RT）方式以及社会人口统计学特征的详细信息。使用 Cochran-Armitage 检验评估每个病例使用 10 次或更少 RT 分割的使用趋势。从支付者的角度计算每个病例的总费用，并以 2017 年的美元报告；使用线性回归评估成本的时间趋势。广义线性模型确定了使用 10 次或更少分割的治疗的预测因素。
在确定的 51533 个病例中，46326 个使用二维/三维 RT，3199 个使用调强 RT，2008 个使用立体定向体 RT。使用 10 次或更少分割的 2D/3D RT 病例比例从 65.5%增加到 79.7%（P<0.001），每个病例的总费用从 6742 美元降至 6067 美元（P<0.001）。二维/三维治疗中单次放射治疗的使用略有增加（从 6.5%增加到 8.1%；P<0.001）。10 次或更少分割的预测因素包括最近几年的治疗、年龄较大（≥85 岁）和更高的合并症评分。根据地理位置和主要癌症，观察到了差异。
在美国放射肿瘤学会、美国内科医师学会和国家质量论坛发起的质量改进计划期间，用于骨转移的 10 次或更少分割的使用率增加了 14.2%，但单次分割方案仅增加了 1.6%，突出了质量改进的机会。
