title: Increasing use of advanced radiation therapy technologies in the last 30 days of life among patients dying as a result of cancer in the United States.
abstract: OBJECTIVE
  We sought to analyze trends in radiation therapy (RT) technology use and costs in the last 30 days of life for patients dying as a result of cancer.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare and Texas Cancer Registry-Medicare databases to analyze claims data for 13,488 patients dying as a result of lung, breast, prostate, colorectal, melanoma, and pancreas cancers from 2000 to 2009. Logistic regression modeling was used to conduct adjusted analyses regarding influence of demographic, clinical, and health services variables on receipt of types of RT. Costs were calculated in 2009 US dollars.
  
  
  RESULTS
  The proportion of patients treated with two-dimensional RT decreased from 74.9% of those receiving RT in the last 30 days of life in 2000 to 32.7% in 2009 (P < .001). Those receiving three-dimensional RT increased from 27.2% in 2000 to 58.5% in 2009 (P < .001). The proportion of patients treated with intensity-modulated radiation therapy in the last 30 days of life increased from 0% in 2000 to 6.2% in 2009 (P < .001), and those undergoing stereotactic radiosurgery increased from 0% in 2000 to 5.0% in 2009 (P < .001). The adjusted mean costs of per-patient RT services delivered in the last 30 days of life were higher in the years 2007 to 2009.
  
  
  CONCLUSIONS
  Among patients receiving RT in the last month of life, there was a shift away from the simplest technique toward more advanced RT technologies. Studies are needed to ascertain whether these technology shifts improve palliative outcomes and quality of life for patients dying as a result of cancer who receive RT services.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX; and University of Chicago, Chicago, IL aguadagn@mdanderson.org.
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX; and University of Chicago, Chicago, IL.
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX; and University of Chicago, Chicago, IL.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX; and University of Chicago, Chicago, IL.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Elting
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX; and University of Chicago, Chicago, IL.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, TX; and University of Chicago, Chicago, IL.
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics / Q000401:mortality / Q000532:radiotherapy*; D011878:Radiotherapy / Q000191:economics / Q000706:statistics & numerical data; D018426:SEER Program; D013727:Terminal Care / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
references.citation: J Clin Oncol. 2013 Jan 1;31(1):80-7
references.pmid: 23169520
references.citation: Am J Clin Oncol. 2013 Dec;36(6):630-6
references.pmid: 22134513
references.citation: J Clin Oncol. 2003 Mar 15;21(6):1133-8
references.pmid: 12637481
references.citation: Health Serv Res. 2010 Apr;45(2):565-76
references.pmid: 20148984
references.citation: Cancer. 2013 Mar 1;119(5):1089-97
references.pmid: 23132206
references.citation: Cancer. 2010 Jul 1;116(13):3078-9
references.pmid: 20564639
references.citation: Cancer Res Treat. 2011 Jun;43(2):75-82
references.pmid: 21811422
references.citation: J Palliat Med. 2008 Jun;11(5):723-8
references.pmid: 18588404
references.citation: Ann Epidemiol. 2007 Aug;17(8):584-90
references.pmid: 17531502
references.citation: Support Care Cancer. 2013 Aug;21(8):2229-35
references.pmid: 23503800
references.citation: Med Care. 2006 Oct;44(10):921-8
references.pmid: 17001263
references.citation: N Engl J Med. 2012 Jan 26;366(4):289-91
references.pmid: 22187962
references.citation: J Clin Oncol. 2011 Jun 10;29(17):2305-11
references.pmid: 21537034
references.citation: Radiother Oncol. 2001 Jun;59(3):311-8
references.pmid: 11369073
references.citation: Med Care. 1993 Aug;31(8):732-48
references.pmid: 8336512
references.citation: Lancet. 2011 Oct 15;378(9800):1408-13
references.pmid: 21982520
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references.pmid: 12187163
references.citation: Lancet Oncol. 2008 Apr;9(4):367-75
references.pmid: 18374290
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Cancer. 2005 Sep 15;104(6):1296-303
references.pmid: 16078260
references.citation: BMJ. 2003 Jul 26;327(7408):195-8
references.pmid: 12881260
references.citation: J Natl Cancer Inst. 2008 May 7;100(9):630-41
references.pmid: 18445825
references.citation: Cancer. 2014 Mar 1;120(5):702-10
references.pmid: 24421077
references.citation: Int J Radiat Oncol Biol Phys. 1999 Nov 1;45(4):1081-8
references.pmid: 10571218
references.citation: J Clin Epidemiol. 2000 Dec;53(12):1258-67
references.pmid: 11146273
references.citation: J Clin Oncol. 2004 Jan 15;22(2):315-21
references.pmid: 14722041
references.citation: CA Cancer J Clin. 2010 Sep-Oct;60(5):277-300
references.pmid: 20610543
references.citation: Expert Rev Anticancer Ther. 2011 Nov;11(11):1731-8
references.pmid: 22050022
references.citation: Int J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):824-9
references.pmid: 16682137
references.citation: Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):1047-57
references.pmid: 22284028
references.citation: Biostatistics. 2005 Jan;6(1):93-109
references.pmid: 15618530