Palliative Radiotherapy May Be Overused in Late-Stage Lung Cancer
Almost half of patients with advanced lung cancer receive more than the recommended number of radiation treatments to reduce their pain, according to a new study published by Koshy et al in the Journal of the National Cancer Institute.
Radiation therapy that is palliative can reduce the pain from lung tumors and improve quality of life. However, unnecessary treatments add to costs and require needless trips to the hospital and can lead to radiation toxicity and difficulty in swallowing.
Guidelines developed from clinical trials recommend no more than 15 radiation treatments be given for pain in stage IV lung cancer. The guidelines recommend that patients not receive chemotherapy at the same time, to reduce the risk of toxicity.
Study Findings
This new analysis looked at 47,000 patients who received palliative radiation for stage IV lung cancer in the United States between 2004 and 2012. Researchers found that about one in five had received chemotherapy at the same time. Nearly one-third of patients received more than 25 radiation treatments—10 above the recommended maximum.
“This study uncovered that there's a lot of treatment of late-stage lung cancer with palliative radiation that goes beyond what is recommended by several national guidelines and multiple clinical trials,” said Matthew Koshy, MD, a radiation oncologist at the University of Illinois Hospital and Health Sciences System.
“More education is needed for radiation oncologists, to prevent overtreatment, which has not been proven to further improve symptoms or quality of life and can have some significant side effects,” Dr. Koshy said.
Overtreatment Risk Factors
The researchers also looked for any particular type of patient more likely to be overtreated. “Having private insurance was the number one predictor of being overtreated,” Dr. Koshy said. Privately insured patients were 40% more likely than others to receive more than the recommended 15 treatments. Patients treated in a community cancer center were also more likely to be overtreated.
Dr. Koshy said physicians might tend to overtreat privately insured patients because services are billed per treatment, creating a financial incentive. However, he said, “it could also be because these patients may be perceived to have better potential for a more positive outcome.”
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
