The cost implications of palliative radiation therapy dose and fractionation for painful metastatic bone lesions.

145 Background: Palliative radiation treatment (pRT) is used for symptomatic bone metastases (mets). Several fractionation schedules show equal efficacy for pain relief, and ASTRO’s Choosing Wisely recommends 8Gy x1, 4Gy x5, or 3Gy x10. This study aims to investigate the cost implications of pRT for bone mets. Methods: Patients (Pts) treated with pRT for bone mets at Mayo Clinic from 2007 - 2016 were included in this study. Costs for all services were subdivided into RT and total costs at 30 & 90 days (30D & 90D). Standardized costs were obtained from the Mayo Clinic Cost Data Warehouse and Medicare reimbursements were assigned to all services with cost to charge adjustments and 2017 GDP Implicit Price Deflator for inflation. Cost means were compared via the Kruskal-Wallis test. Results: 538 pts were treated with pRT, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Pts with breast and prostate cancer were most likely to be treated with 3Gy x10 and pts with GI and lung cancer were most likely to be treated with 8Gy x1. RT costs at 30D were $1,497, $1,891, and $1,982 (p=0.03) and RT costs at 90D were $2,602, $2,753, and $3,032 (p=0.08) for initial RT regimens of 8Gy x1, 4Gy x5, and 3Gy x10. Total costs of care at 30D were similar from $15,969 - 17,687 (p=0.6) and total costs at 90D were similar from $22,361 - 23,219 (p=0.7) between arms. A total of 23%, 28%, and 39% of pts were alive 2 years following pRT from each arm (p=0.07). Conclusions: This is the first study of its kind to analyze actual treatment costs for the three most common pRT regimens in bone mets. Single fraction RT was most used for pts with poor prognoses and was associated with lower RT costs at 30D, but similar RT costs at 90D, possibly due to retreatment. RT choice had no impact on overall costs of care at 30D or 90D. pRT remains of high value, representing only 11-13% of total costs.[Table: see text]

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Longitudinal trends in costs for palliative radiation for metastatic prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6554 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6554-6554

Author(s):

Timothy J Robinson ◽

Michaela A Dinan ◽

Yanhong Li ◽

Robert Lee ◽

Shelby D. Reed

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Radiation Therapy ◽

End Of Life ◽

Metastatic Prostate Cancer ◽

Radiation Treatment ◽

Inclusion Criteria ◽

Palliative Radiation ◽

Palliative Radiation Therapy ◽

Bony Metastases

6554 Background: Prostate cancer is a leading contributor to cancer health care costs, with end of life care composing a substantial portion of overall costs. In recent years, palliative treatment of metastases has been characterized by the use of more complex radiation planning and delivery systems. However, little is known about how costs of palliative radiation treatment in patients with metastatic prostate cancer have changed over this period. Methods: Retrospective analysis of SEER-Medicare data of men aged 66 and older who died from metastatic prostate cancer between 2000 and 2007. Inclusion criteria included all fee-for-service beneficiaries treated with radiation therapy for bony metastases in the last year of life. Direct costs were obtained by summing Medicare carrier and outpatient facility payments for all radiation treatment claims following an initial radiation treatment claim for bony metastases and adjusted to 2008 dollars using Consumer Price Indexes for medical care. Results: A total of 1,705 men met study inclusion criteria. Median age at diagnosis was 74, median time from diagnosis to death was 47 months, and 37% of men had distant metastatic disease at the time of diagnosis. Total Medicare payments for radiation therapy for bony metastases increased from an average of $2,763 to $3,989 for men who died from prostate cancer in 2000 vs. 2007. Outpatient facility claims for radiation therapy increased relative to carrier claims, composing 48% ($1,316) and 57% ($2,276) of all radiation treatment Medicare payments in 2000 vs. 2007 (All P < 0.001). Conclusions: Between 2000 and 2007, average Medicare payments for palliative radiation therapy for bony prostate cancer metastases increased by roughly a third. The majority of increased costs were observed within outpatient facility claims, suggesting a shift in the administration of palliative radiation therapy from free-standing clinics to hospital-based outpatient facilities. Changes in end of life palliative radiation therapy for men with prostate cancer may impact future increases in Medicare health care expenditures.

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(P089) Comparison of Survival by Different Palliative Radiation Therapy Fractionation Schedules

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.02.185 ◽

2017 ◽

Vol 98 (2) ◽

pp. E39

Author(s):

Sara A. Dudley ◽

Sonya Aggarwal ◽

Yushen Qian ◽

Aadel Chaudhuri ◽

Kiran Kumar ◽

...

Keyword(s):

Radiation Therapy ◽

Palliative Radiation ◽

Palliative Radiation Therapy ◽

Fractionation Schedules

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Advanced Renal Cell Cancer and Low-Dose Palliative Radiation Treatment: A Case of a Substantial and Sustained Treatment Response

Case Reports in Oncology ◽

10.1159/000493913 ◽

2018 ◽

Vol 11 (3) ◽

pp. 756-762 ◽

Cited By ~ 2

Author(s):

Kirsten van Gysen ◽

Andrew Kneebone ◽

Thomas Eade ◽

Alexander Guminski ◽

George Hruby

Keyword(s):

Cell Carcinoma ◽

Renal Cell ◽

Low Dose ◽

Radiation Treatment ◽

Cell Cancer ◽

Palliative Radiation ◽

Improved Outcomes ◽

Palliative Radiation Therapy ◽

Systemic Agents ◽

Advanced Renal Cell Cancer

Clear cell carcinoma is the most common form of renal cell carcinoma (RCC). Metastatic RCC is poorly responsive to treatment and has a bleak prognosis. Newer systemic agents have improved outcomes. Furthermore, their interaction with radiation treatment (RT) may provide further therapeutic options. RCC is considered to be radioresistant, however we report the case of a patient with progression on targeted therapy and immunotherapy who achieved a substantial and sustained local, and possibly abscopal, response to low dose palliative radiation therapy.

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Variation in Use of High-Cost Technologies for Palliative Radiation Therapy by Radiation Oncologists

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2020.7633 ◽

2021 ◽

Vol 19 (4) ◽

pp. 421-431

Author(s):

Aileen B. Chen ◽

Jiangong Niu ◽

Angel M. Cronin ◽

Ya-Chen Tina Shih ◽

Sharon Giordano ◽

...

Keyword(s):

Radiation Therapy ◽

Random Effects ◽

Case Mix ◽

Patient Case ◽

Palliative Radiation ◽

Costs Of Care ◽

Advanced Technologies ◽

Radiation Oncologists ◽

Metastatic Lung ◽

Palliative Radiation Therapy

Background: Understanding the sources of variation in the use of high-cost technologies is important for developing effective strategies to control costs of care. Palliative radiation therapy (RT) is a discretionary treatment and its use may vary based on patient and clinician factors. Methods: Using data from the SEER-Medicare linked database, we identified patients diagnosed with metastatic lung, prostate, breast, and colorectal cancers in 2010 through 2015 who received RT, and the radiation oncologists who treated them. The costs of radiation services for each patient over a 90-day episode were calculated, and radiation oncologists were assigned to cost quintiles. The use of advanced technologies (eg, intensity-modulated radiation, stereotactic RT) and the number of RT treatments (eg, any site, bone only) were identified. Multivariable random-effects models were constructed to estimate the proportion of variation in the use of advanced technologies and extended fractionation (>10 fractions) that could be explained by patient fixed effects versus physician random effects. Results: We identified 37,361 patients with metastatic lung cancer, 3,684 with metastatic breast cancer, 5,323 with metastatic prostate cancer, and 8,726 with metastatic colorectal cancer, with 34%, 27%, 22%, and 9% receiving RT within the first year, respectively. The use of advanced technologies and extended fractionation was associated with higher costs of care. Compared with the patient case-mix, physician variation accounted for a larger proportion of the variation in the use of advanced technologies for palliative RT and the use of extended fractionation. Conclusions: Differences in radiation oncologists’ practice and choices, rather than differences in patient case-mix, accounted for a greater proportion of the variation in the use of advanced technologies and high-cost radiation services.

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Toxicity following palliative radiation therapy for painful metastatic bone lesions.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.126 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 126-126 ◽

Cited By ~ 1

Author(s):

Mikayla Jenkins ◽

Mark Raymond Waddle ◽

Tasneem Kaleem ◽

William C Stross ◽

Timothy D Malouff ◽

...

Keyword(s):

Bone Metastases ◽

Radiation Treatment ◽

Performance Status ◽

Poor Performance ◽

Patient Characteristics ◽

Bone Lesions ◽

Poor Performance Status ◽

Financial Toxicity ◽

Palliative Radiation ◽

Ed Visits

126 Background: Palliative radiation treatment (pRT) is a common and effective treatment for patients with symptomatic bone metastases. However, patients receiving RT for bone metastases often may have a poor performance status and are more likely to experience toxicity during or after treatment. This study aims to investigate the number and type of toxicity event occurring during or after pRT for bone metastases. Methods: Patients treated with RT for bone metastases at Mayo Clinic from 2007 to 2016 were included in this study. Demographic, disease, treatment, and toxicity information were collected. Specifically, toxicity events were identified as emergency department (ED) visits and inpatient hospitalization (IH) within 90 days, breaks in treatment >4 days, and excessive 30 day financial toxicity defined as standardized Medicare costs >1 standard deviation above the mean. RT treatment was compared by dose and fractionation via descriptive statistics. Results: A total of 538 patients treated with pRT were identified, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Patients with breast and prostate cancer were most likely to be treated with 3Gy x10 and patients with GI and Lung cancer were most likely to be treated with 8Gy x1. A description of the patient characteristics and toxicities are shown in Table 1. For 8Gy x1, 4Gy x5, and 3Gy x10 breaks in treatment were rare (0%, 2%, and 3.3%), ED visits (15%, 24%, & 28%), IH (12%, 23%, & 19%), and financial toxicity (13%, 18%, & 21%) were common. A total of 22.6%, 27.5%, and 38.6% of patients were alive two years following pRT from each group. Conclusions: Toxicity during or shortly after pRT of bone metastases is common. This study confirms that additional steps should be taken to monitor and mitigate toxicity in this vulnerable patient group. [Table: see text]

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Comparison of Survival by Different Palliative Radiation Therapy Fractionation Schedules

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2016.06.1919 ◽

2016 ◽

Vol 96 (2) ◽

pp. E515

Author(s):

S.A. Dudley ◽

Y. Qian ◽

S. Aggarwal ◽

A.A. Chaudhuri ◽

K.A. Kumar ◽

...

Keyword(s):

Radiation Therapy ◽

Palliative Radiation ◽

Palliative Radiation Therapy ◽

Fractionation Schedules

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Safety and clinical activity of intratumoral MEDI9197 alone and in combination with durvalumab and/or palliative radiation therapy in patients with advanced solid tumors

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-001095 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001095 ◽

Cited By ~ 1

Author(s):

Lillian Siu ◽

Joshua Brody ◽

Shilpa Gupta ◽

Aurélien Marabelle ◽

Antonio Jimeno ◽

...

Keyword(s):

Radiation Therapy ◽

Solid Tumors ◽

Phase 1 ◽

Objective Response ◽

Clinical Activity ◽

Advanced Solid Tumors ◽

Palliative Radiation ◽

Cell Counts ◽

Palliative Radiation Therapy ◽

Grade 3

BackgroundMEDI9197 is an intratumorally administered toll-like receptor 7 and 8 agonist. In mice, MEDI9197 modulated antitumor immune responses, inhibited tumor growth and increased survival. This first-time-in-human, phase 1 study evaluated MEDI9197 with or without the programmed cell death ligand-1 (PD-L1) inhibitor durvalumab and/or palliative radiation therapy (RT) for advanced solid tumors.Patients and methodsEligible patients had at least one cutaneous, subcutaneous, or deep-seated lesion suitable for intratumoral (IT) injection. Dose escalation used a standard 3+3 design. Patients received IT MEDI9197 0.005–0.055 mg with or without RT (part 1), or IT MEDI9197 0.005 or 0.012 mg plus durvalumab 1500 mg intravenous with or without RT (part 3), in 4-week cycles. Primary endpoints were safety and tolerability. Secondary endpoints included pharmacokinetics, pharmacodynamics, and objective response based on Response Evaluation Criteria for Solid Tumors version 1.1. Exploratory endpoints included tumor and peripheral biomarkers that correlate with biological activity or predict response.ResultsFrom November 2015 to March 2018, part 1 enrolled 35 patients and part 3 enrolled 17 patients; five in part 1 and 2 in part 3 received RT. The maximum tolerated dose of MEDI9197 monotherapy was 0.037 mg, with dose-limiting toxicity (DLT) of cytokine release syndrome in two patients (one grade 3, one grade 4) and 0.012 mg in combination with durvalumab 1500 mg with DLT of MEDI9197-related hemorrhagic shock in one patient (grade 5) following liver metastasis rupture after two cycles of MEDI9197. Across parts 1 and 3, the most frequent MEDI9197-related adverse events (AEs) of any grade were fever (56%), fatigue (31%), and nausea (21%). The most frequent MEDI9197-related grade ≥3 events were decreased lymphocytes (15%), neutrophils (10%), and white cell counts (10%). MEDI9197 increased tumoral CD8+ and PD-L1+ cells, inducing type 1 and 2 interferons and Th1 response. There were no objective clinical responses; 10 patients in part 1 and 3 patients in part 3 had stable disease ≥8 weeks.ConclusionIT MEDI9197 was feasible for subcutaneous/cutaneous lesions but AEs precluded its use in deep-seated lesions. Although no patients responded, MEDI9197 induced systemic and intratumoral immune activation, indicating potential value in combination regimens in other patient populations.Trial registration numberNCT02556463.

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