Radiotherapy utilization in the last 30 days before death among patients with malignant neoplasms in Japan: a claims...

Radiotherapy (RT) utilization in the last 30 days before death has been reported at 5-10%, but data from Japan are lacking. This study aimed to characterize patterns of end-of-life RT utilization among patients with malignant neoplasms in Japan.

Using the DeSC insurance claims database, patients who died between May 2016 and December 2024 with a primary malignant neoplasm diagnosis were identified. RT utilization in the last 30 days before death, treatment techniques, and the proportions of potentially excessive RT (IMRT, stereotactic irradiation, particle beam therapy, or ≥ 11 treatment days) and single-fraction RT were examined. Multivariable logistic regression was used to explore factors associated with RT utilization and single-fraction RT use.

Among 329,230 deceased patients, 8799 (2.7%) received RT in the last 30 days before death. Potentially excessive RT was observed in 33.7%, declining from 43.1% in 2016 to 27.2% in 2024. Single-fraction RT accounted for 5.5%, increasing from 2.8% in 2016 to 8.8% in 2024. On multivariable analysis, older age, higher comorbidity, and palliative care unit admission were associated with non-use of RT, while bone metastasis, higher-function hospitals, and urban location were associated with higher utilization. Bone metastasis, palliative care unit admission, and higher hospital function were associated with greater single-fraction RT use.

The end-of-life RT utilization rate in Japan was 2.7%, lower than rates reported in other countries. Potentially excessive RT showed a declining trend, while single-fraction RT showed an increasing trend. These findings provide baseline data for optimizing end-of-life RT practices in Japan.