Less is More: SometimesF. Amos Bailey, MD Sep 14, 2021
There are so many things we do out of habit. Things that maybe we just don’t need to do anymore. Does anyone need a “landline” when they have a mobile phone? And don’t get me started on pennies! They are so pointless, and they cost more to produce than they are worth. While the number of landlines is falling, the Penny lobby remains strong and we will have them around for the foreseeable future.
Radiation therapy has several habits that are not that helpful. One is multiple fractions when one could/would do just fine. There are times when prolonged radiation treatment is needed, particularly when the goal is cure. We have known for some time now that a single fraction of radiation for bone metastasis is effective. Now we have an article in JAMA demonstrating that a single fraction to a lung metastasis was equivalent to a longer course (Siva et al., 2021). This study was done in Australia and many of the other short-course radiation studies have been from Europe. However, the habit is that we give 5, 10, 15, or longer fractions which have patients and caregivers going to the radiation center multiple times. This results in valuable time of the patient being spent in unneeded treatment and added financial cost. Adam Fundytus (2021) and colleagues wrote in a recent essay;
“Finally, although current value frameworks and economic models have allowed us to better quantify the net benefit associated with cancer therapy, holistic cancer care must consider patient time, which, for many, is the most important variable of all.”
We will need to be advocates for short courses of treatment when appropriate and guard the value of time.
Siva S, Bressel M, Mai T, et al. Single-Fraction vs Multifraction Stereotactic Ablative Body Radiotherapy for Pulmonary Oligometastases (SAFRON II): The Trans Tasman Radiation Oncology Group 13.01 Phase 2 Randomized Clinical Trial. JAMA Oncol. Published online August 29, 2021. doi:10.1001/jamaoncol.2021.2939
Fundytus A, Prasad V, Booth CM. Has the Current Oncology Value Paradigm Forgotten Patients’ Time? Too Little of a Good Thing. JAMA Oncol. Published online August 26, 2021. doi:10.1001/jamaoncol.2021.3600