title: Patterns of care among patients receiving radiation therapy for bone metastases at a large academic institution.
abstract: OBJECTIVE
  This study evaluates outcomes and patterns of care among patients receiving radiation therapy (RT) for bone metastases at a high-volume academic institution.
  
  
  METHODS
  Records of all patients whose final RT course was for bone metastases from April 2007 to July 2012 were identified from electronic medical records. Chart review yielded demographic and clinical data. Rates of complicated versus uncomplicated bone metastases were not analyzed.
  
  
  RESULTS
  We identified 339 patients whose final RT course was for bone metastases. Of these, 52.2% were male; median age was 65 years old. The most common primary was non-small-cell lung cancer (29%). Most patients (83%) were prescribed ≤10 fractions; 8% received single-fraction RT. Most patients (52%) had a documented goals of care (GOC) discussion with their radiation oncologist; hospice referral rates were higher when patients had such discussions (66% with vs 50% without GOC discussion, P=.004). Median life expectancy after RT was 96 days. Median survival after RT was shorter based on inpatient as opposed to outpatient status at the time of consultation (35 vs 136 days, respectively, P<.001). Hospice referrals occurred for 56% of patients, with a median interval between completion of RT and hospice referral of 29 days and a median hospice stay of 22 days.
  
  
  CONCLUSIONS
  These data document excellent adherence to American Society for Radiation Oncolology Choosing Wisely recommendation to avoid routinely using >10 fractions of palliative RT for bone metastasis. Nonetheless, single-fraction RT remains relatively uncommon. Participating in GOC discussions with a radiation oncologist is associated with higher rates of hospice referral. Inpatient status at consultation is associated with short survival.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Susannah G
authors.initials: SG
authors.lastname: Ellsworth
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: salcorn2@jhmi.edu.
authors.forename: Sara R
authors.initials: SR
authors.lastname: Alcorn
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Russell K
authors.initials: RK
authors.lastname: Hales
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Todd R
authors.initials: TR
authors.lastname: McNutt
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Theodore L
authors.initials: TL
authors.lastname: DeWeese
authors.affiliation: Department of Medical Oncology and Harry J. Duffey Family Program in Palliative Care, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017051:Hospice Care / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017567:Karnofsky Performance Status; D007902:Length of Stay; D008017:Life Expectancy; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms; D011879:Radiotherapy Dosage; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult