Palliative radiotherapy (PRT) makes up about half of all courses delivered in radiotherapy departments. The expected increase in the need for radiotherapy demands that PRT should be delivered with the most effective and efficient regimens available, yet there remains widespread variation in practice. The aim of this study was to identify variation in PRT fractionation for bone and brain metastases in New South Wales (NSW) and factors associated with variation.

Patients who received PRT for bone and brain metastases (2009-2014) were identified from a linked dataset comprising data from the NSW Central Cancer Registry, the NSW Cancer Institute Electronic Radiotherapy Oncology Data (extract of radiotherapy data from each NSW public and private facility) and Admitted Patient Data Collection. For bone metastases, the outcome was documented use of single-fraction RT (SFRT) and multi-fraction RT (MFRT), while for brain metastases, the outcome was documented use of <6, 6-10 and >10 fractions fractions. We evaluated factors potentially associated...

Bone metastases 14,629 courses of PRT for bone metastases were analysed. 4,398 courses (30%) were SFRT and 10,204 courses (70%) were MFRT. There was significant change in SFRT use over time from 2009 to 2014, but no apparent trend (P =0.04). There was wide variation in the proportion of SFRT used across residence LHDs, ranging from 14% to 48%. [Fig 1] SFRT was more likely to be delivered to: older patients: 34% in patients ≥80 years, and 28% in patients <60 years (P <0.001). male...

Considerable variation in the use of PRT fractionation was identified, highlighting the need for interventions to reduce variation. Better efforts are urgently needed to embed practical solutions to lessen unnecessary variations in practice. For example, evidence shows that facilitated feedback methods and models focussing on changing clinician behaviour are effective in responding to variation. Given the frailty of some patients undergoing PRT, excessive fractionation should be avoided, not only to ensure that all interventions are cost-effective, but importantly, to minimise undue burden on patients at...

-