The Effect of Race in the Palliative Treatment of Bone Metastases

Prior studies demonstrated that single and multiple-fraction radiation therapy (RT) provide comparable pain relief in palliative-care patients. In addition, unconscious racial biases may affect practice patterns in oncology. In this study, we examined the effect of race on the duration of RT for palliative treatment of bone metastases.

This is a retrospective study of 707 patients treated for bone metastases between 2013 and 2020 (1348 treatments). Patient race, demographics, RT dose, number of fractions, use of stereotactic radiosurgery (SRS), and performance score were collected. A short-course was defined as a single fraction, whereas a long-course was defined as more than one fraction. SRS cases were analyzed separately.

Of all nonradiosurgery RT treatments delivered, 28.9% were single fraction and 71.1% were multiple fraction. In total, 76% of the patients were White and 24% were non-White. With regard to race, the number of White patients receiving short- and long-course RT was 256 (27.9%) and 663 (72.1%), respectively. The number of non-White patients receiving short- and long-course RT was 97 (31.9%) and 207 (68.1%), respectively. There was no difference in treatment duration based on patient race (P = .20). The use of SRS did not vary based on race (P = .79). There was no statistically significant difference in Karnofsky Performance Status Scale score between White and non-White patients (P = .44).

Analysis of patient and physician characteristics revealed that race did not influence treatment decisions such as duration of palliative RT regimen or use of SRS. Although palliative-care regimens must be individualized for each patient, such investigations can identify potential biases in treatment decisions.