3549 - Neuropsychological Screening, Advance Care Planning, and End-of-Life Care among Vulnerable Older Adults Undergoing Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer

02:30pm - 03:45pm PT

Hall F

Screen: 31

POSTER

Presenter(s)

Leah Thompson, MD - Harvard Radiation Oncology Program, Boston, MA

L. L. Thompson¹, J. Yoon², C. Florissi², S. M. Lipson³, A. T. Gregg², P. M. Amin², S. Shah², N. Anabaraonye², S. Jiang², E. Baxter², A. Saraf⁴, R. B. Jimenez⁵, and R. H. Mak⁶; ¹Harvard Radiation Oncology Program, Boston, MA, ²Harvard Medical School, Boston, MA, ³Dana-Farber Brigham Cancer Center, Boston, MA, ⁴Dana-Farber Cancer Institute, Boston, MA, ⁵Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, ⁶Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Purpose/Objective(s):

Older adults undergoing stereotactic body radiotherapy (SBRT) often have geriatric vulnerabilities. For vulnerable patients, neuropsychological evaluation (NPE) and advanced care planning (ACP) are recommended. Capacity and mood evaluation inform ACP, which in turn shapes supportive and end-of-life (EOL) care. However, these parameters remain under-investigated in vulnerable non-small cell lung cancer (NSCLC) SBRT cohorts. Therefore, we characterized patterns of NPE / legally binding ACP (LB-ACP) and relationships between LB-ACP and high-intensity EOL care in this population.

Materials/Methods: We reviewed the records of vulnerable (G8 score =14) patients aged =65 with early-stage NSCLC that completed SBRT 01/01/17-12/31/22, abstracting demographic/clinical history, NPE, and LB-ACP (healthcare-proxy, living will[LW], Medical-Orders-for-Life-Sustaining Treatment[MOLST]) at SBRT start and one-year post-SBRT. Among deceased patients, we collected LB-ACP one month pre-death and receipt of high-intensity EOL care (ER-visit/hospitalization, >14 inpatient days, death-in-hospital in the final month, ICU admission/death or defibrillation/ventilation/intubation/resuscitation in the final two weeks). We tabulated descriptive statistics and examined relationships between LB-ACP and high-intensity EOL care using regressions adjusted for age, sex, stage, and functional status.

Results:

Among 291 patients (median age 79.3 years, 62.9% female), 37.1% had a history of dementia or depression. Mood and cognitive screening were infrequent at SBRT start (0.7%, 1.0%) and one year post-SBRT (12.0%, 3.8%). Though most patients had LB-ACP across time-points (64.4% at SBRT-start, 70.8% post-SBRT), there were persistently low rates of LB-ACP subtypes delineating specific EOL care goals (i.e. LW/MOLST; 11.0% pre-SBRT, 18.9% one-year post-SBRT). Among the deceased, 74.6% received high-intensity EOL care. Patients with LW/MOLST had reduced odds of high-intensity EOL care (OR=0.23,95%CI 0.59-0.88,p=0.032) compared to those with no LB-ACP, while those with less specific LB-ACP had similar odds to those no LB-ACP.

Conclusion:

This study demonstrates a clear gap in NPE and LB-ACP delivery in the care of vulnerable NSCLC patients receiving SBRT. Future work should explore quality improvement initiatives, such as trigger tools or best practice advisories, to improve NPE and ACP delivery.