3393 - Analysis of Urgent Starts for Radiotherapy that Occur on Weekends at an Academic Institution
Presenter(s)
M. Charles1, B. Y. Durkee2, and B. M. Anderson1; 1Department of Human Oncology, University of Wisconsin Hospitals and Clinics, Madison, WI, 2Department of Human Oncology, University of Wisconsin, Madison, WI
Purpose/Objective(s): Providing timely and cost-effective care for oncology patients is a high priority goal. While radiotherapy (RT) is primarily delivered on an outpatient basis during regular business days, hospital-based centers often have an on-call team that provides care to patients with urgent cancer-related symptoms after hours. The purpose of this study is to retrospectively evaluate treatment indications, timeliness of care, and outcomes achieved in patients initiated on urgent RT for predominantly palliative indications at an academic institution on the weekends.
Materials/Methods: From 01/01/2023-12/31/2023, a total of 66 patients were initiated on a course of urgent RT over a weekend (defined as treatment outside of 7:30 a.m. – 5:45 p.m., Monday-Friday). We collected data regarding diagnosis, RT indication, timeline of treatment, and overall survival (OS). For inpatients, we also gathered data regarding objective documentation of improvement in symptoms prior to discharge. Descriptive statistics were used to summarize clinical data. Survival outcomes were evaluated using Kaplan-Meier (KM) and log-rank tests.
Results: Of the 66 patients analyzed, 40 (60.6%) were inpatient at the time of consultation and RT initiation, with a median time from admission to RT initiation of 4 days. The most common indication for RT was symptomatic bone metastases (SBM), which accounted for over half of the patients (n = 38; 57.6%). Among the 38 patients with SBM, 6 patients (9.1%) also had spinal canal narrowing or spinal cord compression. Other common indications included extensive brain metastases requiring whole brain RT (n = 6; 9.1%), uncontrolled bleeding (n = 6; 9.1%), bronchial obstruction or superior vena cava syndrome (n = 5; 7.6%), and bowel obstruction (n = 2; 3.0%). The remainder of patients (n = 9; 13.6%) were treated for other indications.
The median OS calculated from date of RT initiation was 3.9 (0.4; 25.9) months for the entire cohort of 66 patients, 5.6 (0.4; 25.8) months for SBM, and 1.9 (0.4; 21.3) months for patients who were hospitalized at RT initiation. Among the 38 patients with SBM, 21 (55.3%) were inpatient during RT, and 7 of 21 inpatients (33.3%) had documented symptom improvement prior to discharge. For all inpatient consults who were evaluated and began treatment while inpatient, 16 of 40 (40.0%) had documented symptom improvement prior to discharge.
Conclusion: Over a one-year period, SBM accounted for approximately half of patients initiated on urgent RT on weekends. The short OS time of patients hospitalized at the time of urgent RT highlights the importance of utilizing single-fraction regimens and optimizing patient selection to ensure the opportunity for benefit from RT. Future studies will also explore the potential to improve timeliness of care initiation and cost-effectiveness by building a more robust palliative radiotherapy practice integrated with the inpatient oncology care team.