2909 - Assessment of Palliative Radiotherapy Quality in a Rural Prefecture of Japan: A Multi-Institution Study
Presenter(s)
Y. Wada1, A. Anbai2, M. Hashimoto3, M. Toshima4, O. Watanabe5, Y. Hatayama6,7, M. Obata7, Y. Sugawara8, D. Kaneko9, K. Ito10, H. Katou11, and N. Mori12; 1Akita University Graduate School of Medicine, Akita, Japan, 2Department of Radiology, Omagari Kosei Medical Center, Omagari, Japan, 3Department of Radiation Oncology, Akita City Hospital, Akita, Japan, 4Department of Radiation Oncology, Akita Kousei Medial Center, Akita, Japan, 5Department of Radiation Oncology, Akita Red Cross Hospital, Akita, Japan, 6Department of Radiation Oncology, Hirosaki University, Hirosaki, Japan, 7Department of Radiology, Odate Municipal General Hospital, Odate, Japan, 8Department of Radiology, Yuri Kumiai General Hospital, Yuri-Honjo, Japan, 9Department of Radiology, Noshiro Kousei Medical Center, Noshiro, Japan, 10Department of Radiology, Hiraka General Hospital, Yokote, Japan, 11Department of Radiology, Nakadori General Hospital, Akita, Japan, 12Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
Purpose/Objective(s):
This study was conducted in a rural prefecture of Japan with the highest cancer mortality, advanced aging, and rapid population decline nationwide. These issues are expected to emerge globally. Currently, the radiotherapy facilities in this region are highly decentralized. However, further population decline will necessitate reorganization of the facilities, possibly leading to regional disparities. This study assessed palliative radiotherapy (PRT) quality across the rural prefecture using validated quality indicators (QIs, Adv Radiat Oncol 2021) with reference to whether decentralized radiotherapy facilities contribute to equitable PRT quality.Materials/Methods:
This multi-institution retrospective study included all 10 radiotherapy facilities in the prefecture. We collected data on patient age, ECOG performance status (PS), time from referral to PRT, and the seven QIs shown in Table 1. From each facility, data of the first 10 consecutive patients with bone metastases and 10 with brain metastases treated since January 2023 were collected. The facilities were categorized into capital (n=5) and non-capital (n=5) hospitals. Group comparisons used ?² tests with Yates’ correction or the Mann–Whitney U test.Results:
The median age at PRT initiation was 72 years (p = 0.56), and the median PS was 2 (p = 0.37) in both groups. The median time from referral to PRT was shorter in capital than in non-capital hospitals (3 days [0–25] vs 4 [0–22]; p = 0.03). Among the QIs, appropriate fractionation for bone metastases was less frequently observed in capital than in non-capital hospitals (87% vs 100%; p = 0.03). No significant differences were observed in the other QIs.Conclusion:
In this rural prefecture of Japan, no significant differences were observed between capital and non-capital hospitals in terms of PRT quality, except for the time from referral to PRT and fractionation for bone metastases. The ability to deliver timely and appropriate PRT to elderly patients with relatively poor PS suggests the importance of decentralized radiotherapy facilities for maintaining equitable quality of PRT in rural regions. Table 1. Quality Indicators for Palliative Radiotherapy QIs based on validated measures (Adv Radiat Oncol 2021). *p<0.05| Site | QIs | Definition | Capital Hospitals (%) | Non-Capital Hospitals (%) | p value |
| Bone metastases | Fractionation | =10 fractions or rationales documented | 87 | 100 | 0.03* |
| Pretreatment pain assessment | Pain documented before RT by radiation oncologists | 70 | 82 | 1.00 | |
| Timely RT for spinal cord compression | RT started same or next day | 67 | 78 | 0.43 | |
| Steroid use for spinal cord compression | Steroids initiated/increased | 8 | 18 | 0.40 | |
| Brain Metastases | Pretreatment clinical assessment | Clinical status documented before RT by radiation oncologist | 74 | 81 | 0.77 |
| Completion of whole-brain RT | RT course completed | 81 | 84 | 0.27 | |
| No delay in RT initiation | RT started within 10 days | 100 | 98 | 1.00 |