Consulting services increase radiation receipt, reduce hospital stays for bone metastases

The establishment of the Palliative Radiation Oncology Consult Service nearly doubled the use of single-fraction and hypofractionated radiation while improving pain management among patients with advanced cancer and bone metastases, according to study results presented at the Palliative Care in Oncology Symposium.

Further, the establishment of the service increased the use of palliative care consult services, decreased inpatient palliative radiation use and decreased length of hospital stay, according to the researchers.

“Randomized phase 3 data has shown that as little as one fraction [of radiation treatment] can be just as efficacious as 10 fractions, but shorter courses of treatment are underutilized,” Kavita Dharmarajan, MD, MSc, assistant professor of radiation oncology, geriatrics and palliative medicine at Icahn School of Medicine at Mount Sinai, said during a press conference. “We proposed an intervention that combined the core principles of palliative care with technical and procedural principles of radiation oncology and service models that prioritized a whole patient approach and management plan.”

Despite strong evidence regarding its efficacy in symptom management, single-fraction radiation treatment and ≤ 5 fraction radiation treatment (hypo-RT) are underutilized among palliative patients with advanced cancer, according to study background.

The Palliative Radiation Oncology Consult Service (PROC) was established in 2013 as a specialty service to provide individualized, efficient treatment for this patient population by a radiation oncology team with a palliative focus.

Chang and colleagues sought to assess the impact of the PROC on the use of single-fraction radiation, hypo-RT, pain management, palliative care use and hospitalization among patients receiving palliative radiation for bone metastases.

The researchers searched electronic charts of patients with advanced cancer who underwent palliative radiation for symptomatic bone metastases between December 2010 and April 2015.

They evaluated data regarding palliative radiation details, cancer type, pain levels before and after treatment, comorbidities, palliative care consults, and hospitalization.

The study included data from 334 patients (pre-PROC, n = 211; post-PROC, n = 123). Median age (pre-PROC, 62 years; post-PROC, 61 years) and median Charlson comorbidity index (pre-PROC, 9; range, 2-15; post-PROC, 9; range, 2-16) appeared comparable between the cohorts.

Following the establishment of the PROC, patients appeared more likely to receive single-fraction radiation (14% vs. 26%; OR = 2.2; 95% CI, 1.2-3.8) and hypo-RT (28% vs. 52%; OR = 3; 95% CI, 1.8-47).

Further, fewer patients were treated as inpatients following the establishment of the PROC (47% vs. 33%; P = .01). The median length of hospital stay decreased from 21 days (range, 0-96) prior to PROC to 14 days (0-118) following its establishment (P = .04).

Receipt of palliative care services within 1 month of palliative radiation also increased (26% vs. 39%; P = .01).

“Increasing the use of short course radiation treatment is associated with reduced time spent in the hospital, for patients and their families,” Dharmarajan said. “These patients are more likely to finish their treatment and to get support from palliative care. The rates of pain improvement are similar to that of traditional length treatment.” – by Cameron Kelsall

Reference:

Chang S, et al. Abstract 110. Scheduled for presentation at: Palliative Care in Oncology Symposium; October 9-10, 2015; Boston.

Disclosure: The researchers report no relevant financial disclosures.