Does Dissemination of Guidelines Alone Increase the Use of Palliative Single-Fraction Radiotherapy? Initial Report of a Longitudinal Change Management Campaign at a Provincial Cancer Program

Background: Despite level 1 evidence demonstrating the equivalence of single-fraction radiotherapy (SFRT) and multiple-fraction radiotherapy (MFRT) for the palliation of painful bone metastases, SFRT remains underused. In 2015, to encourage the sustainable use of palliative radiation oncology resources, CancerCare Manitoba disseminated, to each radiation oncologist in Manitoba, guidelines from Choosing Wisely Canada (CWC) that recommend SFRT. We assessed whether dissemination of the guidelines influenced SFRT use in Manitoba in 2016, and we identified factors associated with MFRT. Methods: All patients treated with palliative radiotherapy for bone metastasis in Manitoba from 1 January 2016 to 31 December 2016 were identified from the provincial radiotherapy database. Patient, treatment, and disease characteristics were extracted from the electronic medical record and tabulated by fractionation schedule. Univariable and multivariable logistic regression analyses were performed to identify risk factors associated with MFRT. Results: In 2016, 807 patients (mean age: 70 years; range: 35–96 years) received palliative radiotherapy for bone metastasis, with 69% of the patients having uncomplicated bone metastasis. The most common primary malignancies were prostate (27.1%), lung (20.6%), and breast cancer (15.9%). In 62% of cases, MFRT was used—a proportion that was unchanged from 2015. On multivariable analysis, a gastrointestinal [odds ratio (OR): 5.3] or lung primary (OR: 3.3), complicated bone metastasis (OR: 4.3), and treatment at a subsidiary site (or: 4.4) increased the odds of MFRT use. Conclusions: Dissemination of cwc recommendations alone did not increase SFRT use by radiation oncologists in 2016. A more comprehensive knowledge translation effort is therefore warranted and is now underway to encourage increased uptake of SFRT in Manitoba.