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Unnecessary RT Given Near End of Life in Metastatic Cancer

Guideline-nonconcordant radiotherapy given to substantial proportion of Medicare beneficiaries with metastatic cancer near the end of life

TUESDAY, Jan. 18, 2022 (HealthDay News) — Among patients with bone and brain metastases who died within 90 days of radiotherapy receipt, 21.6 percent received guideline-nonconcordant therapy, according to a research letter published online Jan. 14 in JAMA Health Forum.

Patricia Mae G. Santos, M.D., from the Memorial Sloan Kettering Cancer Center in New York City, and colleagues conducted a cross-sectional study to examine guideline concordance of radiotherapy administered within the last three months of life to patients aged 65 years or older with bone or brain metastases.

The researchers found that 17,482 episodes were associated with patient death within 90 days of radiotherapy (51.3 and 48.7 percent bone metastases and brain metastases, respectively). Of the patients who died within 90 days of radiotherapy, 78.4 and 21.6 percent received guideline-concordant radiotherapy and guideline-nonconcordant radiotherapy, respectively. Factors associated with reduced odds of guideline-nonconcordant therapy included treatment in hospital-affiliated facilities (adjusted odds ratio, 0.50) and older patient age (age 75 to 85 and 85 years or older versus 65 to 75 years: adjusted odds ratios, 0.90 and 0.73, respectively). Factors associated with increased odds of guideline-nonconcordant therapy included receipt of major procedures, chemotherapy, and survival more than 30 days after a treatment planning appointment.

“Our findings suggest that the burden of unnecessary radiotherapy in the metastatic setting is shared by a sizeable proportion of patients near the end of life, underscoring the importance of guideline adherence,” the authors write.

Two authors disclosed financial ties to pharmaceutical and health care companies; two authors disclosed ties to eContour.org, a nonprofit educational website.

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