title: Assessment of national practice for palliative radiation therapy for bone metastases suggests marked underutilization of single-fraction regimens in the United States.
abstract: OBJECTIVE
  To characterize temporal trends in the application of various bone metastasis fractionations within the United States during the past decade, using the National Cancer Data Base; the primary aim was to determine whether clinical practice in the United States has changed over time to reflect the published randomized evidence and the growing movement for value-based treatment decisions.
  
  
  METHODS
  The National Cancer Data Base was used to identify patients treated to osseous metastases from breast, prostate, and lung cancer. Utilization of single-fraction versus multiple-fraction radiation therapy was compared according to demographic, disease-related, and health care system details.
  
  
  RESULTS
  We included 24,992 patients treated during the period 2005-2011 for bone metastases. Among patients treated to non-spinal/vertebral sites (n=9011), 4.7% received 8 Gy in 1 fraction, whereas 95.3% received multiple-fraction treatment. Over time the proportion of patients receiving a single fraction of 8 Gy increased (from 3.4% in 2005 to 7.5% in 2011). Numerous independent predictors of single-fraction treatment were identified, including older age, farther travel distance for treatment, academic treatment facility, and non-private health insurance (P<.05).
  
  
  CONCLUSIONS
  Single-fraction palliative radiation therapy regimens are significantly underutilized in current practice in the United States. Further efforts are needed to address this issue, such that evidence-based and cost-conscious care becomes more commonplace.
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut. Electronic address: charles.rutter@yale.edu.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rutter
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
authors.forename: Lynn D
authors.initials: LD
authors.lastname: Wilson
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, New Haven, Connecticut.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data / Q000639:trends*; D011471:Prostatic Neoplasms; D011878:Radiotherapy / Q000706:statistics & numerical data; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D014481:United States