(Press-News.org) PHILADELPHIA -- For cancer patients dealing with the pain of tumors that have spread to their bones, doctors typically recommend radiation as a palliative therapy. But as in many areas of medicine, more of this treatment isn't actually better. Medical evidence over the past decade has demonstrated that patients with terminal cancer who receive a single session of radiotherapy get just as much pain relief as those who receive multiple treatments. But despite its obvious advantages for patient comfort and convenience – and the associated cost savings – this so-called single-fraction treatment has yet to be adopted in routine practice. That's the finding of a new study from researchers led by the Perelman School of Medicine at the University of Pennsylvania published today in JAMA.
"Increased use of single fraction treatment would achieve the Holy Grail of health reform, which is real improvements in patient care at substantial cost savings," said the new study's lead author, Justin E. Bekelman, MD, an assistant professor of Radiation Oncology in Penn Medicine’s Abramson Cancer Center. Yet so far, he notes, "despite the evidence, single fraction treatment is used rarely and it's reserved for patients with the poorest prognosis."
Bekelman and his colleagues examined at a group of 3,050 patients 65 years and older treated with radiotherapy for advanced prostate cancer and bone metastases. In the analysis of patients drawn from the national Surveillance, Epidemiology and End Results (SEER)-Medicare database, they found that only 3 percent of patients studied received just single-fraction treatment, and nearly half the patients had more than 10 treatments. The costs of the excess treatments, the authors found, were substantial: Mean 45-day radiotherapy-related expenditures were 62 percent lower for patients who received one treatment, at $1,873 for single vs. $4,967 for multiple fractions.
Professional societies have recommended single-fraction treatment over multiple fractions for routine pain control, except in cases with complications that require specialized therapy, such as spinal cord compression or broken bones caused by tumors.
Bekelman's findings underscore the importance of efforts such as the Choosing Wisely campaign, which seeks to identify and promote medical practices that offer the highest value and best outcome for patients. Bekelman's data shows that patients are routinely receiving extra radiation treatments that drive up health care costs, without conferring additional benefits to patients.
"Whether you get more or less radiation for bone metastases has nothing to do with survival," he says. "When clear and consistent evidence exists that supports single fraction treatment, we should proceed with the treatment that has equivalent pain control, is more convenient, and gets patients out of treatment quicker."
###
Co-authors of the study are Ezekiel Emanuel, MD, PhD, also of Penn Medicine, and Andrew J. Epstein, PhD of the Philadelphia Veterans Affairs Medical Center.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $398 million awarded in the 2012 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.
Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2012, Penn Medicine provided $827 million to benefit our community.
END
Previous studies of exposure to aircraft noise have examined the risk of hypertension, but few have examined the risk of cardiovascular disease and results are inconsistent. So researchers based in London set out to investigate the risks of stroke and heart disease in relation to aircraft noise among 3.6 million residents living near London Heathrow, one of the busiest airports in the world.
They compared hospital admissions and mortality rates for stroke, coronary heart disease, and cardiovascular disease from 2001-05 in 12 London Boroughs and nine districts west of ...
Professor Geir Hoff and colleagues in Norway, argue that we need more evidence about the malignant potential of benign lesions to be sure that the risks of removing them do not outweigh the benefits of screening.
Bowel cancer screening has increased the detection of benign polyps (fleshy growths on the lining of the colon or rectum). The most common polyps found during screening are adenomas and guidelines recommend that they are removed.
However, data show that less than 5% of adenomas develop into colorectal cancer, suggesting that 95% of procedures may be exposing ...
Risks of hospital admissions and deaths from stroke, heart and circulatory disease are higher in areas with high levels of aircraft noise, a study has found.
Researchers at Imperial College London and King's College London compared data on day- and night-time aircraft noise with hospital admissions and mortality rates among a population of 3.6 million people living near Heathrow airport.
The risks were around 10 to 20 per cent higher in areas with highest levels of aircraft noise compared with the areas with least noise.
The findings are published in the British Medical ...
VIDEO:
Growth of a bacterial colony (green) over about 60 hours is shown. The blue "on " signal spreads outward from the center; red represents the "off " signal triggered over time.
Click here for more information.
DURHAM, N.C. -- Working with a synthetic gene circuit designed to coax bacteria to grow in a predictable ring pattern, Duke University scientists have revealed an underappreciated contributor to natural pattern formation: time.
In a ...
Boston, MA — Older people exposed to aircraft noise, especially at high levels, may face increased risk of being hospitalized for cardiovascular disease, according to a new study from Harvard School of Public Health (HSPH) and Boston University School of Public Health (BUSPH). Researchers found that, on average, zip codes with 10-decibel higher aircraft noise had a 3.5% higher cardiovascular hospital admission rate.
It is the first major study to estimate the association between residential exposure to aircraft noise and cardiovascular hospitalizations, using data on ...
Augusta, Ga. - A simple video camera paired with complex algorithms appears to provide an accurate means to remotely monitor heart and respiration rates day or night, researchers report.
The inexpensive method for monitoring the vital signs without touching a patient could have major implications for telemedicine, including enabling rapid detection of a heart attack or stroke occurring at home and helping avoid sudden infant death syndrome, according to a study published in the journal PLOS ONE.
It also may enable untethered, more realistic monitoring of laboratory ...
A study led by Dr. Anthony Traboulsee of the University of British Columbia and Vancouver Coastal Health to see whether narrowing of the veins from the brain to the heart could be a cause of multiple sclerosis has found that the condition is just as prevalent in people without the disease.
The results, published in the U.K. medical journal The Lancet, call into question a controversial theory that MS is associated with a disorder proponents call chronic cerebrospinal venous insufficiency (CCSVI).
The study used both ultrasound and catheter venography (an x-ray of the ...
PROVIDENCE, R.I. [Brown University] — Researchers from Brown University and King's College London have gained surprising new insights into how brain anatomy influences language acquisition in young children.
Their study, published in the Journal of Neuroscience, found that the explosion of language acquisition that typically occurs in children between 2 and 4 years old is not reflected in substantial changes in brain asymmetry. Structures that support language ability tend to be localized on the left side of the brain. For that reason, the researchers expected to see ...
ITHACA, N.Y. – School cafeterias that accept only electronic payments may be inadvertently promoting junkier food and adding empty calories to students' diets, say Cornell behavioral economists in the current issue of the journal Obesity.
Paper and videos: http://foodpsychology.cornell.edu/op/debitcard
To expedite long lunch lines and enable cleaner accounting, about 80 percent of schools use debit cards or accounts that parents can add money to for cafeteria lunch transactions, write David Just and Brian Wansink, co-directors of the Cornell Center for Behavioral Economics ...
NORTH GRAFTON, Mass. (October 8, 2013) – A recently published study suggests that exposure to social stress not only impairs a mother's ability to care for her children but can also negatively impact her daughter's ability to provide maternal care to future offspring.
Researchers at the Cummings School of Veterinary Medicine at Tufts University conducted a transgenerational study with female rats, examining the behavioral and physiological changes in mothers exposed to chronic social stress early in life as a model for postpartum depression and anxiety.
A different ...
