Purpose/Objective(s):
Thirty-day mortality (30DM) is a proposed marker for harm reduction as treatment within 30 days of death results in logistical, time, and financial toxicity with limited benefit. We hypothesize that a dedicated palliative inpatient radiation oncology consult (IROC) service will result in low rates of 30DM and low rates of incomplete radiation (RT) courses in high-risk patients.
Materials/Methods:
From its inception on November 1, 2022, until December 31, 2024, all IROC consultations were retrospectively reviewed. Charts were queried for data: age, sex, disease primary, consult reason, RT indication, site treated, fraction number. Associations were determined via chai squared and independent T tests. Overall survival (OS) was determined via Kaplan-Meier method. Primary end points were 30DM, defined as death within 30 days of simulation, and percent of RT courses not completed.
Results:
1638 consults were received over 25 months with 633 (39%) undergoing simulation. OS was poor at 3.4 months (95%CI: 3.0-3.9) for all consults. RT was not completed in 11% with 75% of these attributed to death or hospice transition. Predictors of failure to complete treatment included treatment of the spine (P=0.006), 10 fraction regimens (P=0.012), >10 fraction regimens (P=0.003), and 30DM (P<0.001). Among the 128 patients (20%) who died within 30 days of simulation, single fraction treatment was more common (P=0.001). Treatment for pain was the only associated factor with higher 30DM (P=0.003).
Conclusion:
30DM is a proposed marker for harm reduction as treatment within 30 days of death results in logistical, time, and financial toxicity with limited benefit. Our palliative IROC service has achieved the recommended 30DM rate of =20% despite poor survival in this patient population. A reduction in fraction number for these patients resulted in low rates of incomplete treatment (11%), with many transfers to hospice. This demonstrates having a dedicated palliative service that emphasizes goals of care and quality of life leads to reduction in the aforementioned toxicities near the end of life. Incorporation of other prognostic metrics such as performance status and labs such as LDH and albumin will be assessed in the future to determine whether they may predict 30DM and incomplete palliative RT courses.
