Age Disparity in Palliative Radiation Therapy Among Patients With Advanced Cancer


      Palliative radiation therapy represents an important treatment option among patients with advanced cancer, although research shows decreased use among older patients. This study evaluated age-related patterns of palliative radiation use among an elderly Medicare population.

      Methods and Materials

      We identified 63,221 patients with metastatic lung, breast, prostate, or colorectal cancer diagnosed between 2000 and 2007 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database. Receipt of palliative radiation therapy was extracted from Medicare claims. Multivariate Poisson regression analysis determined residual age-related disparity in the receipt of palliative radiation therapy after controlling for confounding covariates including age-related differences in patient and demographic covariates, length of life, and patient preferences for aggressive cancer therapy.


      The use of radiation decreased steadily with increasing patient age. Forty-two percent of patients aged 66 to 69 received palliative radiation therapy. Rates of palliative radiation decreased to 38%, 32%, 24%, and 14% among patients aged 70 to 74, 75 to 79, 80 to 84, and over 85, respectively. Multivariate analysis found that confounding covariates attenuated these findings, although the decreased relative rate of palliative radiation therapy among the elderly remained clinically and statistically significant. On multivariate analysis, compared to patients 66 to 69 years old, those aged 70 to 74, 75 to 79, 80 to 84, and over 85 had a 7%, 15%, 25%, and 44% decreased rate of receiving palliative radiation, respectively (all P<.0001).


      Age disparity with palliative radiation therapy exists among older cancer patients. Further research should strive to identify barriers to palliative radiation among the elderly, and extra effort should be made to give older patients the opportunity to receive this quality of life-enhancing treatment at the end of life.
      To read this article in full you will need to make a payment
      ASTRO Member Login
      ASTRO Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chow E.
        • Harris K.
        • Fan G.
        • et al.
        Palliative radiotherapy trials for bone metastases: A systematic review.
        J Clin Oncol. 2007; 25: 1423-1436
        • Fairchild A.
        • Harris K.
        • Barnes E.
        • et al.
        Palliative thoracic radiotherapy for lung cancer: A systematic review.
        J Clin Oncol. 2008; 26: 4001-4011
        • Tsao M.N.
        • Lloyd N.
        • Wong R.K.
        • et al.
        Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases.
        Cochrane Database Rev. 2012; 4: CD003869
        • Guadagnolo B.A.
        • Liao K.P.
        • Elting L.
        • et al.
        Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the united states.
        J Clin Oncol. 2013; 31: 80-87
        • Hayman J.A.
        • Abrahamse P.H.
        • Lakhani I.
        • et al.
        Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer.
        Int J Radiat Oncol Biol Phys. 2007; 69: 1001-1007
        • Huang J.
        • Zhou S.
        • Groome P.
        • et al.
        Factors affecting the use of palliative radiotherapy in ontario.
        J Clin Oncol. 2001; 19: 137-144
        • Murphy J.D.
        • Nelson L.M.
        • Chang D.T.
        • et al.
        Patterns of care in palliative radiotherapy: A population-based study.
        J Oncol Pract. 2013; 9: e220-e227
        • Siegel R.
        • Naishadham D.
        • Jemal A.
        Cancer statistics, 2013.
        CA Cancer J Clin. 2013; 63: 11-30
      1. American Medical Association. AMA phyician ICD-9-cm. 2009. ISBN 10: 1603590110.

      2. U.S. Department of Health and Human Services. 2009-2010 area resource file (ARF). Available at: Accessed April 15, 2012.

        • Charlson M.E.
        • Pompei P.
        • Ales K.
        • et al.
        A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-cm administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
        • Warren J.L.
        • Harlan L.C.
        • Fahey A.
        • et al.
        Utility of the seer-medicare data to identify chemotherapy use.
        Med Care. 2002; 40: IV-55-61
        • Earle C.C.
        • Neville B.A.
        • Landrum M.B.
        • et al.
        Trends in the aggressiveness of cancer care near the end of life.
        J Clin Oncol. 2004; 22: 315-321
        • Zou G.
        A modified poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
        • Goodwin J.S.
        • Hunt W.C.
        • Samet J.M.
        Determinants of cancer therapy in elderly patients.
        Cancer. 1993; 72: 594-601
        • Yellen S.B.
        • Cella D.F.
        • Leslie W.T.
        Age and clinical decision making in oncology patients.
        J Natl Cancer Inst. 1994; 86: 1766-1770
      3. Westhoff PG, de Graeff A, Reyners AK, et al. Response and quality of life in elderly with painful bone metastases: results from a randomized radiotherapy study icon. Presented at: 2nd European Society for Therapeutic Radiology and Oncology (ESTRO) Forum. Geneva, Switzerland. April 19-23, 2013.

        • Gaspar L.
        • Scott C.
        • Rotman M.
        • et al.
        Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials.
        Int J Radiat Oncol Biol Phys. 1997; 37: 745-751


      Commenting Guidelines

      To submit a comment for a journal article, please use the space above and note the following:

      • We will review submitted comments as soon as possible, striving for within two business days.
      • This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
      • We require that commenters identify themselves with names and affiliations.
      • Comments must be in compliance with our Terms & Conditions.
      • Comments are not peer-reviewed.