Unwarranted variation in radiation therapy fractionation

Batumalai, Vikneswary; James, Melissa

doi:10.1111/1754-9485.13372

Cited by 3 publications

(3 citation statements)

References 72 publications

(162 reference statements)

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“…We reported large variations in practice and identified several patient, tumour and institutional factors that were associated with different WBRT fractionation use. It is also important to acknowledge that not all variation is unwarranted 25 . Older patients were more likely to be treated with shorter fractionation (≤5 fractions).…”

Section: Discussionmentioning

confidence: 99%

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Variations in whole brain radiation therapy fractionation for brain metastases in Victoria

et al. 2022

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Introduction:We aim to evaluate the use of different whole brain radiation therapy (WBRT) fractionation schedules for brain metastases (BM) in Victoria, and the factors associated with it. Methods: This is a population-based cohort of patients who received radiation therapy for BM between 2012 and 2017, as captured in the Victorian Radiotherapy Minimum Dataset. We excluded patients with primary brain tumour and those who had 'prophylactic' intent treatment. The Cochran-Armitage test was used to evaluate changing trend in WBRT fractionation. Multivariate multinomial logistic regressions were used to evaluate factors associated with WBRT fractionation. Results: Of the 3111 patients who had WBRT, 1048 (45%), 1291 (42%) and 312 (13%) had ≤5, 6-10 and >10 fractions WBRT respectively. There was progressive increase in ≤5 fractions WBRT use over time, from 37% in 2012 to 50% in 2017 (P-trend < 0.001). In multivariate analyses, increasing age, patients with gastrointestinal cancer, patients living in remote/regional areas and more recent treatment were associated with the use of shorter WBRT fractionation (≤5 fractions), while patients who had WBRT plus stereotactic radiosurgery, and those treated in private institutions were associated with the use of prolonged WBRT fractionation (≥6 fractions). Three hundred eightynine (13%) patients died within 30 days of WBRT, of which 241 (64%), 119 (32%) and 17 (5%) had ≤5, 6-10 and > 10 fractions WBRT respectively. Conclusion: We observed large variations in WBRT fractionation that are associated with patient, tumour, treatment and institutional factors. It is important to continuously monitor and benchmark our practice in order to reduce potentially unwarranted variations.

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Section: Discussionmentioning

confidence: 99%

“…It is also important to acknowledge that not all variation is unwarranted. 25 Older patients were more likely to be treated with shorter fractionation (≤5 fractions). Increasing age is generally considered poor prognostic factor for many cancers, and it is an important factor incorporated in the Graded Prognostic Assessment (GPA) for BM.…”

Section: Discussionmentioning

confidence: 99%

Variations in whole brain radiation therapy fractionation for brain metastases in Victoria

et al. 2022

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“…We also observed large variations in RT fractionation use depending on institutional type, with SFRT much more commonly used in public centers. This is an important pattern‐of‐practice study for MM in Australia as it provides us with a baseline benchmark of the contemporary practice pattern for MM to be measured against (which to date, is not available in any published literature) for future quality improvement initiatives to reduce unwarranted variations in practice 22 . With advancement in systemic therapy for MM and as patients with MM are living longer, 15 we anticipate that the pattern of practice of RT for MM‐related bone disease will continue to evolve, not only with respect to RT fractionation, but on the use of advanced RT techniques 19 …”

Section: Discussionmentioning

confidence: 99%

Large variation in radiation therapy fractionation for multiple myeloma in Australia

Ong

MacManus

Milne

et al. 2022

Asia-Pac J Clncl Oncology

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Aim:To evaluate the patterns of use of different radiation therapy (RT) fractionation for multiple myeloma (MM) bone disease.Methods: This is a population-based cohort of patients with MM who had RT between 2012 and 2017 as captured in the statewide Victorian Radiotherapy Minimum Data Set in Australia. Data linkage was performed to identify subsets of RT delivered within 3 months of death. RT fractionation was classified into four groups: single-fraction (SFRT), 2-5, 6-10, and > 10 fractions. Changes in RT fractionation use over time were evaluated with the Cochran-Armitage test for trend. Factors associated with RT fractionation were evaluated using multivariate logistic regressions.Results: Nine hundred and sixty-seven courses of RT were delivered in 623 patients.The proportion of SFRT, 2-5, 6-10 and > 10 fractions RT was 18%, 47%, 28%, and 7%, respectively. There was an increase in the use of 2-5 fractions, from 48% in 2012 to 60% in 2017 (p-trend < .001), with corresponding decrease in the use of 6-10 fractions, from 26% in 2012 to 20% in 2017 (p-trend = .003). Nine percent (40/430) of RT courses at private institutions were SFRT, compared to 25% (135/537) in public institutions (p < .001). In multivariate analyses, treatment in private institution was the strongest predictor of multifraction RT use. SFRT use was more common closer to the end of life--18%, 14%, and 33% of RT within 2-3, 1-2, < 1 month of death, respectively. Conclusion:There is increasing use of shorter course RT (2-5 fractions) for MM over time. SFRT use remains low, with large variation in practice. INTRODUCTIONBone involvement is common in patients with multiple myeloma (MM), with up to 80% of patients with newly diagnosed MM presenting with osteolytic lesions, with high risk of skeletal-related events, such asThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Increased Variation in Esophageal Cancer Treatment and Geographic Healthcare Disparity in Michigan

Lee

Arora

Bergman

et al. 2023

Journal of the American College of Surgeons

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Background: Regional variation in complex healthcare is shown to negatively impact health outcomes. We sought to characterize geographical variance in esophageal cancer surgery in Michigan. Study Design: Data for patients with loco-regional esophageal cancer from the Michigan Cancer Surveillance Program from 2000-2013 was analyzed. We reviewed the incidence of esophageal cancer by county and region, and those with loco-regional disease receiving an esophagectomy. Counties were aggregated into existing state-level “urban vs rural” designations, regions were aggregated using the Michigan Economic Recovery Council designations, and data was analyzed with Anova, F-test, and chi-squared test. Results: 8,664 patients had loco-regional disease, with 2,370 (27.4%) treated with surgery. Men were significantly more likely to receive esophagectomy than women (p<0.001), White more than non-White patients (p<0.001), insured more than non-insured patients (p=0.004), and rural more than urban patients (p<0.001). There were 8 regions and 83 counties, with 61 considered rural, and 22 urban. Region 1 (Detroit metro area, Southeast) contains the largest urban and suburban population and 4 major hospital systems, and was considered the baseline standard for access to care. Regions 2 (West) (p=0.011), 3 (Southwest) (p=0.024), 4 (East Central) (p=0.012), 6 (Northern Lower Peninsula) (p=0.008), and 8 (Upper Peninsula) (p<0.001) all had a statistically significant greater variance in annual rates of surgery compared to Region 1. Region 8 had the largest variance and was the most rural and furthest from Region 1. The variance in surgery rate between urban and rural differed significantly (P = 0.005). Conclusions: A significant increase in variation of care was found in rural vs urban counties, as well as in regions distant to larger hospital systems. Those of male sex, White race, rural residence, and also having insurance were significantly more likely to receive surgery.

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Unwarranted variation in radiation therapy fractionation

Cited by 3 publications

References 72 publications

Variations in whole brain radiation therapy fractionation for brain metastases in Victoria

Variations in whole brain radiation therapy fractionation for brain metastases in Victoria

Large variation in radiation therapy fractionation for multiple myeloma in Australia

Increased Variation in Esophageal Cancer Treatment and Geographic Healthcare Disparity in Michigan

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