Trends in Radiation for Bone Metastasis During a Period of Multiple National Quality Improvement Initiatives
Trends in Radiation for Bone Metastasis During a Period of Multiple National Quality Improvement Initiatives
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DOI：
10.1200/jop.18.00588
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发表时间：
2019-04-01
影响因子：
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通讯作者：
Smith, Benjamin D.
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文献类型：
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作者：
Logan, Jennifer K.;Jiang, Jing;Smith, Benjamin D.
目的评估在一段时间内的多个国家的质量改进计划，重点是减少每次放射epission.METHODS分数和放射骨转移的成本的趋势，使用全国范围内的医疗保险索赔从2011年到2014年，我们确定了放射性发作的骨转移前列腺癌，肺癌和乳腺癌。从索赔中提取了关于分次、放射治疗（RT）方式和社会人口学特征的详细信息。使用Cochran-Armitage检验评价每次发作使用10次或更少RT分数的时间趋势。从付款人的角度计算每集的总成本，并以2017年美元报告;使用线性回归评估成本的时间趋势。结果在51，533例患者中，46，326例使用2D/3D RT，3，199例使用调强RT，2，008例使用立体定向体部RT，2D/3D RT使用10次或更少次的比例从65.5%增加到79.7%（P趋势< .001），平均每次发作的总费用从6，742美元降至6，067美元（P趋势< .001）。2D/3D治疗中单次放疗的使用适度增加（6.5%至8.1%; P趋势<0.001）。10个或更少分数的预测因子包括近年来的治疗、高龄（85岁）和较高的合并症评分。根据地理区域和原发性癌症而注意到差异。结论在美国放射肿瘤学会、美国内科医学委员会和国家质量论坛发起的质量倡议期间，骨转移的10种或更少分次治疗增加了14.2%，但单次治疗方案仅增加了1.6%，凸显了质量改进的机会。(C)2019年美国临床肿瘤学会
PURPOSE 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.METHODS 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.RESULTS 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-trend < .001), and mean total cost per episode decreased from $6,742 to $6,067 (P-trend < .001). Use of single-fraction radiation increased modestly for 2D/3D treatment (6.5% to 8.1%; P-trend < .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.CONCLUSION 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. (C) 2019 by American Society of Clinical Oncology