Use of low-value radiotherapy practices in Canada: an analysis of provincial cancer registry data.
BACKGROUND
As part of Choosing Wisely Canada (a national campaign to encourage patient-provider conversations about unnecessary medical tests, treatments, and procedures), a list of ten oncology practices that could be low-value in some instances was developed. Of those practices, two were specific to radiation therapy (rt): conventional fractionation as part of breast-conserving therapy (bct) for women with early-stage breast cancer, and multifraction radiation for palliation of uncomplicated painful bone metastases. Here, we report baseline findings for the current utilization rates of those two rt practices in Canada.


RESULTS
The use of conventional fractionation as part of bct varied substantially from province to province. Of women 50 years of age and older, between 8.8% (Alberta) and 36.5% (Saskatchewan) received radiation in 25 fractions (excluding boost irradiation) as part of bct. The use of hypofractionated rt (that is, 16 fractions excluding boost irradiation)-a preferred approach for many patients-was more common in all 6 reporting provinces, ranging from 43.2% in Saskatchewan to 94.7% in Prince Edward Island. The use of multifraction rt for palliation of bone metastases also varied from province to province, ranging from 40.3% in British Columbia to 69.0% in Saskatchewan. The most common number of fractions delivered to bone metastases was 1, at 50.2%; the second most common numbers were 2-5 fractions, at 41.7%.


CONCLUSIONS
Understanding variation in the use of potentially low-value rt practices can help to inform future strategies to promote higher-value care, which balances high-quality care with the efficient use of limited system resources. Further work is needed to understand the factors contributing to the interprovincial variation observed and to develop benchmarks for the appropriate rate of use of these rt practices.
Canadian Partnership Against Cancer, Toronto, ON.
K
K
Tran
Canadian Partnership Against Cancer, Toronto, ON.
R
R
Rahal
Departments of Oncology and of Public Health Sciences, Queen's University, Kingston, ON.
M
M
Brundage
Canadian Partnership Against Cancer, Toronto, ON.
S
S
Fung
Canadian Partnership Against Cancer, Toronto, ON.
C
C
Louzado
Department of Radiation Oncology, University of Toronto, and Cancer Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, ON.
M
M
Milosevic
Canadian Partnership Against Cancer, Toronto, ON.
J
J
Xu
Canadian Partnership Against Cancer, Toronto, ON;; Departments of Community Health Sciences and of Oncology, University of Calgary, Calgary, AB.
H
H
Bryant
Breast cancer; appropriateness; bone metastasis; patterns of care; radiation