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Patient Preference for Radiotherapy Fractionation Schedule in the Palliation of Painful Bone Metastases

Thomas P. Shakespeare, Jiade J. Lu, Michael F. Back, Shen Liang, Rahul K. Mukherjee, Christopher J. Wynne

From the Radiotherapy Centre, The Cancer Institute, National University Hospital; and Clinical Trials and Epidemiology Research Unit, Ministry of Health, Singapore.

Address reprint requests to Tom Shakespeare, MD, Radiotherapy Centre, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074; email: ThomasS{at}nuh.com.sg.

Purpose: The radiotherapeutic management of painful bone metastases is controversial, with several institutional and national guidelines advocating use of single-fraction radiotherapy. We aimed to determine patient choice of fractionation schedule after involvement in the decision-making process by use of a decision board.

Patients and Methods: Advantages and disadvantages of two fractionation schedules (24 Gy in six fractions v 8 Gy in one fraction) used in the randomized Dutch Bone Metastasis Study were discussed with patients using a decision board. Patients were asked to choose a fractionation schedule, to give reasons for their choice, and to indicate level of satisfaction with being involved in decision making.

Results: Sixty-two patients were entered. Eighty-five percent (95% confidence interval, 74% to 93%) chose 24 Gy in six fractions over 8 Gy in one fraction (P < .0005). Variables including age, sex, performance status, tumor type, pain score, and paying class were not significantly related to patient choice. Multiple fractionation was chosen for lower re-treatment rates (92%) and fewer fractures (32%). Single-fraction treatment was chosen for cost (11%) and convenience (89%). Eighty-four percent of patients expressed positive opinions about being involved in the decision-making process.

Conclusion: Decision board instruments are feasible and acceptable in an Asian population. The vast majority of patients preferred 24 Gy fractionated radiotherapy compared with a single fraction of 8 Gy. These results indicate the need for further research in this important area and serve to remind both clinicians and national or institutional policy makers of the importance of individual patient preference in treatment decision making.

Awarded the Novartis Prize for Best Scientific Research (Poster Category), Royal Australian and New Zealand College of Radiologists 53^rd Annual Scientific Meeting, Adelaide, Australia, October 3–6, 2002.

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