Advanced Prostate Cancer: Radiation Overused?
Just one session is needed for effective pain relief, but many men get 10, according to researcher
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"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."
In this study of men aged 65 and older, the cost of radiation-related therapy averaged just under $1,900 for men who had one session, but about $5,000 for men who had 10 or more treatments.
"To give doctors the benefit of the doubt," Lawton said, "they may not have been aware of the research (supporting single treatments)."
Although the evidence started coming in more than a decade ago, it was in 2005 that a large U.S. clinical trial showed that a single radiation treatment was just as good as multiple treatments for patients whose cancer had spread to the bones.
The current findings are based on Medicare data for 3,050 U.S. men treated between 2006 and 2009, which might help explain why so few received a single treatment, Lawton said.
But whatever the reasons, she agreed that most patients should get a single session of radiation. Some may then need another treatment after about a year, Lawton noted. "But that's still a lot better than going in for multiple treatments," she said.
And the cost savings are not the primary reason to promote single treatment, Bekelman stressed. "This is a treatment that is just as effective, and shorter, and less expensive. It just makes sense," he said.
He and Lawton said patients should feel free to question their doctor if multiple radiation treatments are recommended for bone pain. "The question should be, 'Am I a candidate for single treatment?' And if not, why not?" Bekelman said.
He added that patients need not worry that doing one radiation treatment instead of several will affect their cancer survival. "The goal with this treatment is to treat pain. It has nothing to do with survival," Bekelman pointed out.