Many people who’ve had cancer that has metastasized to their bones have had to endure multiple doses of radiation to control the pain. But it doesn’t have to be that way. According to recent research, a single dose is just as effective at controlling pain as multiple ones.
The study, led by Justin Bekelman and his colleagues at the University of Pennsylvania, found that as many as 250,000 patients every year suffer from bone cancer pain. But most are still getting the standard treatment of 10 “fractions” or more. For example, only 3.3% of Medicare patients with prostate cancer that had metastasized to the bone got the single-dose treatment.
Why? According to Bekelman, it’s partly about the money. His research indicates that Medicare pays an average of $4,967 for a series of treatments but only $1,873 for a single treatment. “Pretty clearly, practice change might only materialize if payment reform incentivizes high-quality care,” he said in the study. “In this case, it’s not incentivizing high-quality care. In fact, it’s the opposite.”
An additional—and perhaps even more powerful—reason more patients aren’t getting single doses is inertia: Doctors are simply doing what they’ve always done. And getting them to change isn’t going to be easy.
Bekelman points out that radiation is not a life-extending treatment; it only reduces the pain. And while he’s an advocate for single-dose treatments, he says multiple fractions are still recommended in some cases—especially if the cancer has spread to the spine.
The study was published in the Journal of the American Medical Association.
On a related topic, a natural compound in broccoli may offer some protection from tissue damage caused by radiation therapy (or accidentally exposed to radiation).The compound, 3,3′-diindolylmethane (DIM), occurs in broccoli and other cruciferous vegetables, including cauliflower, Brussels sprouts, watercress, bok choy, mustard greens, radishes, and turnips.
“DIM has been studied as a cancer prevention agent for years,” says Eliot Rosen, who coauthored a recent study that involved giving rats lethal doses of gamma radiation. “But this is the first indication that DIM can also act as a radiation protector.”
In the study, some of the exposed rats were injected with a placebo and some were given an injection of DIM. “All of the untreated rats died, but well over half of the DIM-treated animals remained alive 30 days after the radiation exposure,” said Rosen. “DIM could protect normal tissues in patients receiving radiation therapy for cancer, but could also protect individuals from the lethal consequences of a nuclear disaster.”