Development and Implementation of a Clinical Pathway for Radiation of Bone Metastases in a Complex Academic Radiation Oncology Organization

Background: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Evidence around treatment of complicated bone metastases is increasingly nuanced and although the American Society of Radiation Oncology and the American Association of Hospice and Palliative Medicine recommend single fraction radiation therapy (SFRT) for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused clinical pathway on Brigham and Women’s/Dana Farber Cancer Center’s (BW/DFCC) palliative radiation treatment patterns, which are determined by a dedicated palliative radiation consult service (SPRO) at the main BW/DFCC campus, and network physicians who treat more than one disease type at community-based affiliated sites. We hypothesized that pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of SFRT for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, clinical guidelines, and expert input, we designed a comprehensive clinical pathway for bone metastases radiation. Th