155406-165

A palliative radiation oncology consult service’s impact on care of advanced cancer patients with symptomatic bone metastases.

Subcategory: 
Category: 
Integration and Delivery of Palliative Care in Cancer Care
Session Type and Session Title: 
Poster Session A
Oral Abstract Session A
Abstract Number: 

110

Poster Board Number: 
Poster Session A Board #A8
Citation: 
J Clin Oncol 33, 2015 (suppl 29S; abstr 110)
Author(s): 
Sanders Chang, Cardinale B. Smith, R. Sean Morrison, Kenneth Rosenzweig, Kavita Vyas Dharmarajan; Icahn School of Medicine at Mount Sinai, New York, NY; Mount Sinai Medical Center, New York, NY

Abstract Disclosures

Abstract: 

Background: Single-fraction and ≤ 5 fraction radiation treatment (SF-RT and Hypo-RT, respectively) is underutilized despite strong evidence regarding its efficacy in symptom management. Established in 2013, the Palliative Radiation Oncology Consult Service (PROC) is a specialty service designed to provide individualized, efficient treatment for advanced cancer patients by a radiation oncology team with a dedicated palliative care focus. We assessed the impact of this new model of care on use of SF-RT, hypo-RT, pain improvement, palliative care utilization, and hospitalization among patients treated with palliative radiation (PRT) for painful bone metastases. Methods: We searched electronic charts of advanced cancer patients who had PRT for symptomatic bone mets from Dec 2010 to April 2015, extracting PRT details, demographics, cancer type, pain pre- and 1 month post-PRT, comorbidities (summarized using Charlson comorbidity index [CCI]), palliative care consults, and hospitalization. Comparisons were made before and after PROC using chi-square or t-tests. Multivariable logistic regression estimated the likelihood of SF-RT or hypo-RT, controlling for age, gender, cancer type, treatment site, and CCI. Results: We identified 334 patients, described in the table below. Patients were more likely to have SF-RT (OR 2.2, 95% CI [1.2-3.8], p = 0.007), or hypo-RT (OR 3.0, 95% CI [1.8-4.7], p < 0.001) after establishment of PROC. Conclusions: Establishment of a PROC service nearly doubled utilization of SF-RT and hypo-RT while maintaining pain improvement, and was associated with an increased use of palliative care consult services, decreased inpatient PRT use, and decreased length of stay. A dedicated service combining palliative care principles and radiation oncology improved quality of palliative cancer care.

Before PROC
Began (n = 211)
After PROC
Began (n = 123)
p-value
Median age (years)62 (10-96)61 (15-93)0.82
Median CCI9 (2-15)9 (2-16)0.98
Median length of stay (days)21 (0-96)14 (0-118)0.04
Treated as inpatients47%33%0.01
SF-RT courses14%26%0.002
Hypo-RT courses28%52%0.003
Received palliative care services within 1 month of PRT26%39%0.01
Pain improvement after PRT81%84%0.64