TY - JOUR
T1 - Variation in use of high-cost technologies for palliative radiation therapy by radiation oncologists
AU - Chen, Aileen B.
AU - Niu, Jiangong
AU - Cronin, Angel M.
AU - Shih, Ya Chen Tina
AU - Giordano, Sharon
AU - Schrag, Deborah
N1 - Funding Information:
Disclosures: Dr. Shih has disclosed that she has received consulting fees from Pfizer Inc. and is a scientific advisor for AstraZeneca. Dr. Schrag has disclosed that she has received funding from JAMA for editorial services, funding from Pfizer, and institutional research funding from GRAIL and AACR. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article. Funding: This study was supported by grants from the Gloria Spivak Fund and the American Society for Radiation Oncology.
Funding Information:
Dr. Ya-Chen Tina Shih is supported by NCI R01 CA207216. Dr. Sharon Giordano is supported by CPRIT RP160674, Komen SAC150061, and NCI P30 CA016672. This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program at NCI; the Office of Research, Development, and Information, Centers for Medicare & Medicaid Services; Information Management Services, Inc.; and the SEER program tumor registries in the creation of the SEER-Medicare database.
Publisher Copyright:
© 2021 Harborside Press. All rights reserved.
PY - 2021/4
Y1 - 2021/4
N2 - Background: Understanding the sources of variation in the use of high-cost technologies is important for developing effective strategies to control costs of care. Palliative radiation therapy (RT) is a discretionary treatment and its use may vary based on patient and clinician factors. Methods: Using data from the SEER-Medicare linked database, we identified patients diagnosed with metastatic lung, prostate, breast, and colorectal cancers in 2010 through 2015 who received RT, and the radiation oncologists who treated them. The costs of radiation services for each patient over a 90-day episode were calculated, and radiation oncologists were assigned to cost quintiles. The use of advanced technologies (eg, intensity-modulated radiation, stereotactic RT) and the number of RT treatments (eg, any site, bone only) were identified. Multivariable random-effects models were constructed to estimate the proportion of variation in the use of advanced technologies and extended fractionation (>10 fractions) that could be explained by patient fixed effects versus physician random effects. Results: We identified 37,361 patients with metastatic lung cancer, 3,684 with metastatic breast cancer, 5,323 with metastatic prostate cancer, and 8,726 with metastatic colorectal cancer, with 34%, 27%, 22%, and 9% receiving RT within the first year, respectively. The use of advanced technologies and extended fractionation was associated with higher costs of care. Compared with the patient case-mix, physician variation accounted for a larger proportion of the variation in the use of advanced technologies for palliative RT and the use of extended fractionation. Conclusions: Differences in radiation oncologists' practice and choices, rather than differences in patient case-mix, accounted for a greater proportion of the variation in the use of advanced technologies and high-cost radiation services.
AB - Background: Understanding the sources of variation in the use of high-cost technologies is important for developing effective strategies to control costs of care. Palliative radiation therapy (RT) is a discretionary treatment and its use may vary based on patient and clinician factors. Methods: Using data from the SEER-Medicare linked database, we identified patients diagnosed with metastatic lung, prostate, breast, and colorectal cancers in 2010 through 2015 who received RT, and the radiation oncologists who treated them. The costs of radiation services for each patient over a 90-day episode were calculated, and radiation oncologists were assigned to cost quintiles. The use of advanced technologies (eg, intensity-modulated radiation, stereotactic RT) and the number of RT treatments (eg, any site, bone only) were identified. Multivariable random-effects models were constructed to estimate the proportion of variation in the use of advanced technologies and extended fractionation (>10 fractions) that could be explained by patient fixed effects versus physician random effects. Results: We identified 37,361 patients with metastatic lung cancer, 3,684 with metastatic breast cancer, 5,323 with metastatic prostate cancer, and 8,726 with metastatic colorectal cancer, with 34%, 27%, 22%, and 9% receiving RT within the first year, respectively. The use of advanced technologies and extended fractionation was associated with higher costs of care. Compared with the patient case-mix, physician variation accounted for a larger proportion of the variation in the use of advanced technologies for palliative RT and the use of extended fractionation. Conclusions: Differences in radiation oncologists' practice and choices, rather than differences in patient case-mix, accounted for a greater proportion of the variation in the use of advanced technologies and high-cost radiation services.
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U2 - 10.6004/jnccn.2020.7633
DO - 10.6004/jnccn.2020.7633
M3 - Article
C2 - 33578375
AN - SCOPUS:85104276201
SN - 1540-1405
VL - 19
SP - 421
EP - 431
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 4
ER -