Arjun Gupta1, Peiqi Wang2, Ramy Sedhom1, Fumiko Chino3, Mark R Waddle4, Robert C Miller5, David H Johnson6, Nina N Sanford7, Amol Narang8, Sara R Alcorn8, Martin A Makary2,9,10. 1. Department of Medical Oncology, Johns Hopkins University, Baltimore, MD. 2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY. 4. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL. 5. Department of Radiation Oncology, University of Maryland, Baltimore, MD. 6. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX. 7. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX. 8. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. 9. Division of Surgical Oncology, Johns Hopkins University, Baltimore, MD. 10. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Abstract
PURPOSE: Routine use of extended-fraction (> 10 fractions) radiation therapy (RT) for palliation of bone metastases is recognized as a low-value intervention by the American Society for Radiation Oncology. We examined contemporary practice patterns of, and physician characteristics associated with extended-fraction RT use. MATERIALS AND METHODS: We conducted a retrospective cohort study using Medicare fee-for-service data. We included patients who underwent 2- or 3-dimensional external-beam RT for bone metastases between January 1, 2016, and December 31, 2018. Physicians treating > 10 patients over the study period were analyzed for their individual practice. Hierarchic logistic regression modeling was used to identify patient- and physician-level factors associated with extended-fraction RT use. RESULTS: A total of 12,221 patients (median age, 75.6 years; 40.9% women, 87.6% white) were included. The rate of extended-fraction RT was 23.4%. A total of 1,432 physicians treated any patient. Among the 382 physicians treating > 10 patients, 127 (33.2%) used extended-fraction RT > 30% (consensus threshold). Physician factors associated with decreased odds of extended-fraction RT were years since medical school graduation (≤ 10 years and 11-20 years v ≥ 31 years: adjusted odds ratio [aOR], 0.32 [95% CI, 0.20 to 0.51] and 0.64 [95% CI, 0.44 to 0.93]) and practicing in the Northeast or Midwest versus the South (aOR, 0.36 [95% CI, 0.22 to 0.58] and 0.48 [95% CI, 0.31 to 0.74]). Physicians treating > 20 patients (v 11-14 patients) over the study period had increased odds of delivering extended-fraction RT (aOR, 1.53 [95% CI, 1.10 to 2.12]). CONCLUSION: In this study, almost one fourth of patients received extended-fraction RT, and one third of physicians had an extended-fraction RT use rate of > 30%. Personalized feedback of performance data, clinical pathways and peer review, and updated reimbursement models are potential mechanisms to address this low-value care.
PURPOSE: Routine use of extended-fraction (> 10 fractions) radiation therapy (RT) for palliation of bone metastases is recognized as a low-value intervention by the American Society for Radiation Oncology. We examined contemporary practice patterns of, and physician characteristics associated with extended-fraction RT use. MATERIALS AND METHODS: We conducted a retrospective cohort study using Medicare fee-for-service data. We included patients who underwent 2- or 3-dimensional external-beam RT for bone metastases between January 1, 2016, and December 31, 2018. Physicians treating > 10 patients over the study period were analyzed for their individual practice. Hierarchic logistic regression modeling was used to identify patient- and physician-level factors associated with extended-fraction RT use. RESULTS: A total of 12,221 patients (median age, 75.6 years; 40.9% women, 87.6% white) were included. The rate of extended-fraction RT was 23.4%. A total of 1,432 physicians treated any patient. Among the 382 physicians treating > 10 patients, 127 (33.2%) used extended-fraction RT > 30% (consensus threshold). Physician factors associated with decreased odds of extended-fraction RT were years since medical school graduation (≤ 10 years and 11-20 years v ≥ 31 years: adjusted odds ratio [aOR], 0.32 [95% CI, 0.20 to 0.51] and 0.64 [95% CI, 0.44 to 0.93]) and practicing in the Northeast or Midwest versus the South (aOR, 0.36 [95% CI, 0.22 to 0.58] and 0.48 [95% CI, 0.31 to 0.74]). Physicians treating > 20 patients (v 11-14 patients) over the study period had increased odds of delivering extended-fraction RT (aOR, 1.53 [95% CI, 1.10 to 2.12]). CONCLUSION: In this study, almost one fourth of patients received extended-fraction RT, and one third of physicians had an extended-fraction RT use rate of > 30%. Personalized feedback of performance data, clinical pathways and peer review, and updated reimbursement models are potential mechanisms to address this low-value care.
Authors: Patricia Mae G Santos; Kaitlyn Lapen; Zhigang Zhang; Stephanie Lobaugh; C Jillian Tsai; T Jonathan Yang; Justin E Bekelman; Erin F Gillespie Journal: Int J Radiat Oncol Biol Phys Date: 2020-11-12 Impact factor: 7.038
Authors: Erin F Gillespie; Kaitlyn Lapen; Diana G Wang; N Wijetunga; Gerri L Pastrana; Marisa A Kollmeier; Josh Yamada; Adam M Schmitt; Daniel S Higginson; Max Vaynrub; Ernesto Santos Martin; Amy J Xu; C Tsai; Divya Yerramilli; Oren Cahlon; T Yang Journal: Clin Transl Radiat Oncol Date: 2020-10-08