title: Use of single- versus multiple-fraction palliative radiation therapy for bone metastases: population-based analysis of 16,898 courses in a Canadian province.
abstract: OBJECTIVE
  There is abundant evidence that a single fraction (SF) of palliative radiation therapy (RT) for bone metastases is equivalent to more protracted and costly multiple fraction courses. Despite this, there is low utilization of SFRT internationally. We sought to determine the utilization of SFRT in a population-based, publicly funded health care system.
  
  
  METHODS
  All consecutive patients with bone metastases treated with RT during 2007 to 2011 in British Columbia (BC) were identified. Associations between utilization of SFRT and patient and provider characteristics were investigated.
  
  
  RESULTS
  A total of 16,898 courses of RT were delivered to 8601 patients. SFRT was prescribed 49% of the time. There were positive relationships among SFRT utilization and primary tumor group (P<.001; most commonly in prostate cancer), worse prognosis (P<.001), increasing physician experience (P<.001), site of metastases (P<.001; least for spine metastases), and area of training (P<.001; most commonly for oncologists trained in the United Kingdom). There was wide variation in the prescription of SFRT across 5 regional cancer centers, ranging from 25.5% to 73.4%, which persisted after controlling for other, potentially confounding factors (P<.001).
  
  
  CONCLUSIONS
  The large variability in SFRT utilization across BC Cancer Agency (BCCA) cancer centers suggests there is a strong cultural effect, where physicians' use of SFRT is influenced by their colleagues' practice. SFRT use in BC was similar to that in other Canadian and western European reports but strikingly higher than in the United States. Further work is needed to standardize SFRT prescribing practices internationally for this common indication for RT, with the potential for huge health system cost savings and substantial improvements in patients' quality of life.
authors.affiliation: BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: rolson2@bccancer.bc.ca.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Olson
authors.affiliation: BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Tiwana
authors.affiliation: BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Barnes
authors.affiliation: BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kiraly
authors.affiliation: BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of Northern British Columbia, Prince George, British Columbia, Canada.
authors.forename: Kwamena
authors.initials: K
authors.lastname: Beecham
authors.affiliation: BC Cancer Agency Centre for the North, Prince George, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Stacy
authors.initials: S
authors.lastname: Miller
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Agency Centre for the Southern Interior, Kelowna, British Columbia, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hoegler
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada; BC Cancer Agency Vancouver Centre, Victoria, British Columbia, Canada.
authors.forename: Ivo
authors.initials: I
authors.lastname: Olivotto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001955:British Columbia; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D015279:Organizational Culture; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D018787:Radiation Oncology / Q000193:education / Q000706:statistics & numerical data; D011878:Radiotherapy / Q000706:statistics & numerical data; D011879:Radiotherapy Dosage; D055815:Young Adult