title: Availability of single-fraction palliative radiotherapy for cancer patients receiving end-of-life care within the Veterans Healthcare Administration.
abstract: BACKGROUND
  Surveys demonstrate < 20% of radiation oncologists in the United States offer single-fraction palliative radiotherapy (RT) even though it is an acceptable standard of care. A study was conducted to investigate whether this held true for those practicing within the Veterans Healthcare Administration (VHA).
  
  
  METHODS
  All radiation oncologists currently practicing at VHA medical centers were surveyed. Comparisons and associations of responses were evaluated by Fisher's exact test.
  
  
  RESULTS
  The response rate was 90%. Half were full-time employees of the VHA, and the majority (70%) had thoroughly read guidelines on palliative RT for bone metastases recently published by either the American College of Radiology (ACR, 2009, 2012) or the American Society of Radiation Oncology (ASTRO, 2011). Single-fraction palliative RT for bone metastases had been prescribed by 76% of respondents, and 93% had prescribed a short course of ≤ 6 fractions. Respondents were less likely to have prescribed a single fraction for patients who had survival estimates of either > 6 months or > 12 months (66% versus 37%, p < 0.0001).Those not offering single-fraction palliative RT (24%) were more likely to be > 10 years out of training (37% versus 10%, p = 0.01), and to have worked in a private practice setting at some point in their career (36% versus 12%, p = 0.03).
  
  
  CONCLUSIONS
  A majority of radiation oncologists within the VHA offer single-fraction therapy to their patients. These data ensure access to palliative RT is not limited within this health care system by a preference for prolonged treatment courses that may discourage patients and clinicians from seeking this care.
authors.affiliation: 1 Hunter Holmes McGuire Veterans Affairs Medical Center , Richmond, Virginia.
authors.forename: Drew
authors.initials: D
authors.lastname: Moghanaki
authors.forename: Alice V
authors.initials: AV
authors.lastname: Cheuk
authors.forename: Helen
authors.initials: H
authors.lastname: Fosmire
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Anscher
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Lutz
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hagan
authors.forename: George A
authors.initials: GA
authors.lastname: Dawson
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D019983:Guideline Adherence; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D018787:Radiation Oncology / Q000592:standards*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D014481:United States