Use of Advanced Radiation Techniques Increased During Last Year of Life

Although the number of metastatic cancer patients receiving radiation in the last year of life did not significantly change from 2000 to 2007, a new study has found a shift in radiation use from the simplest radiation treatments to more advanced treatment.

A patterns of care study published online in Cancer-by B. Ashleigh Guadagnolo, MD, MPH, of the University of Texas MD Anderson Cancer Center, and colleagues-examined the increased use of intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery (SRS), two advanced radiation techniques that have not been scientifically studied in the United States in patients with advanced-stage cancer.

Using the Surveillance, Epidemiology, and End Results (SEER)–Medicare database, Guadagnolo and colleagues analyzed data from the last 12 months of life of 64,525 patients with metastatic cancer from 2000 to 2007. All patients were aged 65 years or older and had one of five cancers that cause the most cancer deaths: breast, lung, prostate, colorectal, or pancreatic.

Patients in the study survived for a median of 123 days, with 86.2% dying within a year of their diagnosis. Of the patients examined, 29.7% had received a form of radiation after their diagnosis.

“While the proportion of patients receiving radiation in the last year of life for metastatic cancer did not change for most of the past decade, we observed significant trends toward more advanced radiation techniques,” Guadagnolo said.

Specifically, in the year 2000, 0% of patients had received IMRT compared with 4.93% of patients in 2007 (P < .0001). The number of patients receiving SRS also increased from 0.13% in 2000 to 3.72% in 2007 (P < .0001). Overall, the number of patients receiving two-dimensional radiation techniques significantly increased during the study period (P < .0001), and the number of patients receiving three-dimensional radiation techniques significantly increased (P < .0001).

“We have seen increasing rates of IMRT use for treatment of patients with curative disease demonstrated in other patterns of care studies,” Guadagnolo said. “This finding of increased use of IMRT for patients with metastatic disease is consistent with other technology diffusion studies looking at IMRT.”

Patients with pancreatic cancer were among the most likely to received IMRT, the researchers found. In addition, several nonclinical factors, including nonwhite race, married status, being in the lowest neighborhood income quartile, and residing in the Southern SEER region, increased the likelihood of a patient receiving IMRT. Factors that predicted increased receipt of SRS included advancing calendar year, treatment in a hospital-based facility, and Midwest or West/Hawaii SEER region.

“More research is needed into the role of emerging radiation technologies in advanced cancer care with respect to improvement in patient outcomes, physician incentives for advanced technology use, and cost implications for radiation oncology care,” Guadagnolo said.