title: Changing trends in radiation therapy technologies in the last year of life for patients diagnosed with metastatic cancer in the United States.
abstract: BACKGROUND
  Our goal was to investigate utilization trends for advanced radiation therapy (RT) technologies, such as intensity-modulated radiation therapy (IMRT) and stereotactic radiosurgery (SRS), in the last year of life among patients diagnosed with metastatic cancer.
  
  
  METHODS
  We used the Surveillance, Epidemiology and End Results (SEER)-Medicare linked databases to analyze claims data in the last 12 months of life for 64,525 patients diagnosed with metastatic breast, colorectal, lung, pancreas, and prostate cancers from 2000 to 2007. Logistic regression modeling was conducted to analyze potential demographic, health services, and treatment-related variables' influences on receipt of advanced RT.
  
  
  RESULTS
  Among the 19,161 (29.7%) patients who received radiation therapy, there was a significant decrease in the proportion of patients who received the simplest radiation technique (ie, 2D-radiation therapy) (P < .0001), and significant increases in the proportions of patients receiving more advanced radiation techniques (ie, IMRT, and SRS; P < .0001 for all curves); although the rates for use of IMRT and SRS in 2007 remained under 5%. On multivariate analyses, receipt of RT varied significantly by non-clinical characteristics such as race, marital status, neighborhood income, and SEER region. Patients who received hospice care in the last year of life were more likely to receive radiation therapy (OR = 1.35, 95% CI = 1.30-1.40) but less likely to be treated with IMRT (OR = 0.76, 95% CI = 0.62-0.92).
  
  
  CONCLUSIONS
  Although the proportion of patients receiving RT in the last year of life for metastatic cancer did not change for most of the past decade, we observed significant trends toward more advanced radiation techniques.
authors.affiliation: Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. aguadagn@mdanderson.org
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: Jinhai
authors.initials: J
authors.lastname: Huo
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis / Q000532:radiotherapy*; D016634:Radiosurgery / Q000706:statistics & numerical data* / Q000639:trends; D050397:Radiotherapy, Intensity-Modulated / Q000706:statistics & numerical data* / Q000639:trends; D018426:SEER Program; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology