Proportion of people receiving single fraction radiotherapy for bone metastases

Why this indicator is important

Radiotherapy is a common treatment for people with many cancers.

External beam radiotherapy (EBRT) is the recommended treatment for cancer that has spread (metastasised) to the bone and was causing pain without other complications.

Long-term evidence shows radiotherapy treatment using a single fraction (dose) is as effective as using multiple fractions for relieving bone pain for most people with pain and no complications.1 However, for a small number of people, multiple fractions can help reduce the need for retreatment.2

Despite evidence supporting the use of single fractions for most people with pain from secondary spread of cancer to bones, estimates indicate most cancer centres continue to use multiple fractions to treat cancer that has spread to the bone and is causing pain.

About this indicator

This indicator relates to radiotherapy as treatment for cancer-related bone pain.

During 2015–2018, patients with bone metastases (cancer that has spread to the bone) received the following dose of radiotherapy treatment in NSW public facilities:

  • Between 2015 and 2018, of all treatment courses provided to patients with bone metastases (cancer that has spread to the bone) with palliative intent (for pain relief) in NSW public facilities, 34% were received in a single fraction.
  • The proportion of patients with bone metastases receiving a single fraction ranged from 21% to 54%, in 2015–2018. 
     

Proportion of patients with bone metastases receiving single or multiple fractions of external beam radiotherapy with palliative treatment intent in NSW public facilities, with median age, by local health district (LHD) and specialty health network (ranked), 2015–2018

Proportion of patients with bone metastases receiving single or multiple fractions of external beam radiotherapy with palliative treatment intent in NSW public facilities, with median age, by local health district (LHD) and specialty health network (ranked), 2015–2018

N = Number of treatments

Notes:

  1. Data source: NSW Outpatient Radiation Oncology Dataset. Data were extracted from the NSW Cancer Registry (NSWCR) staging database, between April and May 2019. Data available from radiotherapy source systems were incomplete for 2018.
  2. Fractions were estimated using an operational definition. The programming logic to estimate fractions is complex owing to differences in the recording of treatment between individual radiotherapy centres.
  3. New centres and closures in the reporting period: St Vincent's Hospital services transitioned to St Vincent's Private Hospital in August 2015; and Blacktown Cancer and Haematology Centre became operational in April 2016.
  4. Bone metasases: Cancer invasion of the bone from another part of the body.
  5. Palliative treatment: Given primarily for the purpose of pain relief or other symptom control.

References: 

  1. Price P, Hoskin PJ, Easton D, Austin D, Palmer SG, Yarnold JR. Prospective randomised trial of single and multifraction radiotherapy schedules in the treatment of painful bony metastases. Radiother Oncol 1986 Aug;6(4):247–55.
  2. Sze WM, Shelley M, Held I, Mason M. Palliation of metastatic bone pain: single fraction versus multifraction radiotherapy - a systematic review of the randomised trials. Cochrane Database Syst Rev 2004;(2):CD004721.