Advanced Prostate Cancer: Radiation Overused?
Just one session is needed for effective pain relief, but many men get 10, according to researcher
By Amy Norton
TUESDAY, Oct. 8 (HealthDay News) -- Most men given radiation to control pain from advanced prostate cancer undergo more treatments than they really need, a new study suggests.
Once cancer advances to invade the bones, radiation therapy is usually used to ease the pain it causes. And in the past decade, studies have shown that one treatment is enough for most patients.
But those findings have not made it into practice -- at least for older U.S. men with prostate cancer, researchers report in the Oct. 9 issue of the Journal of the American Medical Association.
Looking at Medicare claims data, the investigators found that single-session treatments were done in only about 3 percent of men receiving radiation for prostate cancer that had spread to the bones. What's more, half of the patients went through more than 10 treatments.
The low rate of single treatment is surprising, said Dr. Colleen Lawton, a radiation oncologist who was not involved in the study.
"But it's just as surprising that so many patients had more than 10 fractions," said Lawton, who chairs the board of directors for the American Society for Radiation Oncology.
"Fraction" refers to a session of radiation treatment. Studies have found that one treatment, at a relatively larger dose of 8 Gy, is as effective for pain relief as 20 Gy given over five treatments, or 30 Gy given over 10 treatments.
And that data started emerging in the late 1990s. So it's not clear why so few prostate cancer patients get a single treatment, said lead researcher Dr. Justin Bekelman, of the University of Pennsylvania Perelman School of Medicine in Philadelphia.
"We know that it takes time for clinical trial evidence to get into routine practice. But these findings are nonetheless surprising," Bekelman said.
"The fact is, this is a good treatment that's better for patients," he added. "It's effective, it's more convenient, and better for their quality of life. Single-fraction treatment should be the standard of care."
Lawton said there are some cases where patients might need 10 or more treatments -- such as when the cancer has spread not only to the bones but also to the nearby soft tissue. But that would be only about 10 percent of patients.
"That would not explain the 50 percent in this study," Lawton said.
So what would explain the others? "It's likely a combination of factors," Bekelman said. Some doctors might worry about a recurrence after a single treatment, or the potential need for repeat radiation therapy later on, he noted.
On top of that, Bekelman said, "there's the reimbursement."
Doctors get paid per treatment, so there is a potential financial motivation, Lawton agreed. "I would hope that isn't an impetus," she said, "but it's possible that's part of it."