Search

Purpose/objective(s): At least half of patients who die of cancer suffer from symptoms that adversely affect quality of life, many of which are amenable to palliative radiotherapy (PRT). In this population, urgent assessment and PRT initiation can be beneficial. At our institution, patients requiring PRT can be assessed in multiple settings, including through a dedicated multidisciplinary Palliative Radiation Oncology (PRO) clinic. We examined the logistics of PRT delivery by consultation setting.Materials/methods: This secondary analysis of routinely collected data examined adult female patients with breast cancer who died between 04/01/2013 and 03/31/2014, after at least one course of PRT. During this period, setting and timing of PRT consultation was at the attending physicians' discretion. Patient- and treatment-related data were abstracted including timelines of consultation, simulation (sim), treatment start and PRT completion. Descriptive statistics along with independent t-tests and Chi-square tests were calculated.Results: 65/121 patients had one course of PRT, 33 had two, and 23 had three or more, with on average 1.3 sites treated per course. 27/215 (12.5%) consults took place in the PRO clinic while 166/215 (77.2%) occurred in the on-treatment review clinic. Average interval from referral to consult, consult to sim, and sim to start for PRO visits were 4.7 days, 0 days and 1.8 days respectively; for non-PRO visits, intervals were 4.8 days (P = 0.95), 1.3 days (P = 0.42) and 4.8 days (P = 0.008), respectively. Same day sim occurred in 100% of PRO visits versus 86.2% (162/188) of non PRO visits (P = 0.052). Same day PRT start occurred in 37% of PRO visits versus 23.4% of non-PRO visits (P = 0.13). 44% (11/25) of PRT courses for bone metastases prescribed after PRO visits were single fraction versus 25.6% (46/180) after non-PRO. There were no significant differences in rate of completion of prescribed PRT (100% after PRO vs 98.4% after non-PRO consults) or completion within 14 days of death (3.7% after PRO vs 5.3% after non-PRO).Conclusion: Consultation utilizing dedicated established PRO clinic infrastructure facilitates efficacious PRT delivery. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Despite level one evidence that early integration of specialist palliative care (SPC) improves quality of life, patients tend to access SPC late in their disease trajectory, if at all. Widespread accessibility of generalist PC competencies has been increasingly provided by dedicated palliative radiotherapy (PRT) clinics, such as the multidisciplinary Palliative Radiation Oncology (PRO) program at our institute. We evaluated the interaction between PRT delivery and need for SPC referral.Materials/methods: This secondary analysis of routinely collected health data examined adult female patients with breast cancer, deceased between 04/01/2013 and 03/31/2014. Alberta Cancer Registry, electronic medical records, and Palliative Care Program data were linked. Referrals for PRT and SPC were at the attending physicians' discretion. Clinical data were abstracted including intervals between PRT and SPC consultations. Summary statistics were calculated and independent samples median tests were used for comparison.Results: Of our study cohort of 194 patients, 130 (67.0%) had at least one PRT consult, and 111 (57.2%) were assessed by SPC. First PRT and SPC consultations occurred a median of 11.5 months (interquartile range 3.6-22.1 mos) and 2.8 mos (IQR 0.9 -6.1 mos) before death, respectively. 65.6% (42/64) of those who never had PRT received SPC involvement, versus 53.1% (69/130) of those receiving PRT consult. In the absence of previous PRT, patients had SPC consultation a median of 1.5 mos prior to death (IQR 0.6-4.9 mos); those who had PRT first were seen by SPC a median of 3.3 mos prior (IQR 1.2-6.4 mos) (P = 0.08). Patients seen for PRT outside versus within the PRO clinic had SPC consultation a median of 3.2 mos (IQR 1.2-6.1 mos) versus 5.5 mos prior to death (IQR 2.3-7.1 mos), respectively (P = 0.95).Conclusion: Fewer advanced breast cancer patients who underwent PRT ultimately required SPC consultation, but those who did trended towards referral earlier in their disease course, especially if PRT delivery took place in the setting of a dedicated multidisciplinary team. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): Optimizing provision of supportive care in incurable cancer can be facilitated by routine screening for symptoms and functional interference to direct referrals to appropriate allied health professionals (AHP) and specialist palliative care (SPC). At the Cross Cancer Institute (CCI), patients requiring consultation for palliative radiotherapy (PRT) can be assessed in multiple settings, including through a dedicated multidisciplinary Palliative Radiation Oncology (PRO) clinic. We describe comprehensive needs assessment by setting of PRT consultation.Materials/methods: This secondary analysis of routinely collected data examined female patients with breast cancer who died between 04/01/2013 and 03/31/2014, and had at least one PRT consultation. Systematic screening for patient-reported symptoms was not widespread. Referrals to AHPs and SPC, and setting of PRT consultation, were at the attending physicians' discretion. Clinical data were abstracted including Karnofsky performance status (KPS) and Edmonton Symptom Assessment System (ESAS) ratings. Summary statistics were calculated and t tests of proportions compared groups.Results: Of 130 patients, 9 did not have PRT, 65 had one course, 33 had two, and 23 had three or more, with on average 1.3 sites treated per course. 28/224 (12.5%) total PRT consults took place in the PRO clinic. KPS was documented in 30.1% versus 89.3%; medication history in 53.6% versus 96.4%; and symptom-directed medications in 47.4% versus 96.4% of non-PRO versus PRO visits, respectively (all P < 0.0001). Baseline and follow-up ESAS scores were available for 67.9% and 35.7% of PRO visits, respectively, and not available for any non-PRO visit. PRO consults had a higher proportion of subsequent AHP referrals (50% versus 8.2%; P < 0.0001). Frailty score could be retrospectively derived in 89.3% of PRO versus 44.4% of non-PRO consults (P < 0.0001).Conclusion: Assessment for PRT by a dedicated multidisciplinary team utilizing patient-reported screening tools provides a comprehensive picture of overall function and symptom burden. The resulting ability to tailor supportive care referrals is essential to personalization of end-of-life care. [ABSTRACT FROM AUTHOR]