National Quality Measure Compliance for Palliative Bone Radiation in NSCLC

Findings from a recent study suggest that compliance with the National Quality Forum’s measure 1822 has increased among patients treated for metastatic non–small cell lung cancer (NSCLC), since its introduction in 2012 (J Natl Compr Canc Netw. 2021;1-6. doi:10.6004/jnccn.2020.7688).

In 2012, The National Quality Forum aimed to reduce variation in palliative treatment for bone mestasteses by endorsing measure 1822, a measure that recommends the use of 30 Gy in 10 fractions, 24 Gy in 6 fractions, 20 Gy in 5 fractions, or 8 Gy in a single fraction.

Stephen R Grant, MD, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, and colleagues reported on longitudinal compliance with this measure in this study.

The National Cancer Database was used to identify patients with metastatic NSCLC between 2004 and 2016 who received radiation therapy for bony sites of metastatic disease.

In total, 42,685 patients met the criteria for this study, having treatment courses that reflect one of the four recommended schedules under the National Quality Forum 1822. Authors analyzed rates of compliance by patient, tumor, and treatment characteristics.

Treatment courses that were compliant according to the National Quality Forum increased over time. Compliance was at 69.8% for treatment to the extremity, 48.8% for treatments to the skull or head, 67.1% among academic practice, 56% among community practice, and 61.2% among integrated network facilities.

Multivariable analysis revealed that predictors of the National Quality Forum 1822 compliance included year of diagnosis after 2011, treatment to an extremity, or treatment at an academic facility. Noncompliant courses were associated with community practice, and treatments of the skull or head.

“Among patients treated for metastatic non–small cell lung cancer, compliance with NQF [National Quality Forum] 1822 increased over time,” concluded Dr Grant, adding, “Although extended fractionation constituted a majority of noncompliant treatment courses, a substantial proportion also involved shorter courses.”—Marta Rybczynski