Audit reduces the reluctance to use single fractions for painful bone metastases

We have conducted three audits of the number of fractions used within our department to treat symptomatic bone metastases. The initial audit identified 133 patients treated for bone metastases in a 3-month period using 538 fractions (mean number of fraction = 4.1, range 1-14). These figures were presented at our audit meeting along with a literature review which provided no evidence of any advantage of multiple fractions over single fractions. Departmental guidelines recommending the use of single fractions were established. A subsequent audit identified 149 patients treated with 520 fractions (mean number of fractions = 3.5, range 1-11). A third audit identified 148 patients treated with 335 fractions (mean number of fractions = 2.3, range 1-10). Audit has resulted in a reduction in the number of fractions used to treat bone metastases in our department. The major effect was seen after the second audit.