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PV QA 3 - Poster Viewing Q&A 3

TU_38_2971 - Access to Rehabilitation in Radiation Oncology Patients with High-Grade Glioma

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Access to Rehabilitation in Radiation Oncology Patients with High-Grade Glioma
S. C. Parke1, J. M. Kneeman1, N. Y. Lam1, L. M. Halasz2, and S. E. Day2; 1The University of Washington, Dept of Physical Medicine & Rehabilitation, Seattle, WA, 2University of Washington, Department of Radiation Oncology, Seattle, WA

Purpose/Objective(s): Previous studies suggest that 80% of patients with primary brain tumors have functional deficits. While these deficits are linked to poor outcomes, access to rehabilitation care services (RCS) as a part of interdisciplinary care has not been well-studied. We hypothesized that despite functional deficits, patients with high grade glioma(HGG) underutilize RCS at our NCI-designated Comprehensive Cancer Center.

Materials/Methods: We identified adults with HGG (WHO grade III or IV) who had surgery or biopsy and were presented in 2016 at a weekly multidisciplinary neuro-oncology tumor board (TB) involving radiation oncologists, neuro-oncologists, neurosurgeons, pathologists and radiologists. Demographics, tumor location, and presenting symptoms were collected. RO consults and dates of radiotherapy (RT) were recorded. RCS inpatient consults and outpatient visits, including physical therapy (PT), occupational therapy (OT), speech therapy (SLP), and Physical Medicine and Rehabilitation (PMR), were tracked by a PMR physician, and treatment recommendations were noted.

Results: Sixty-four adults with HGG were presented at TB in 2016. Median age was 55, 36% were female, and 33% and 67% had WHO grade III and IV tumors, respectively. Among HGG patients, 73% had an RO consult, 6% were established patients within the RO department, 13% transferred care outside our system after surgery, and 43% received RT within our system. Rates of RCS consult were high during inpatient hospitalization. Most patients were referred for outpatient RCS due to documented functional deficits, but few attended these appointments (table 1). All patients that received RCS did so during RT, but many patients undergoing RT did not follow up with RCS as recommended. Six patients were readmitted to the inpatient service within 30 days. Of these, half were referred for RCS prior to readmission but did not receive it.
Service: Consult (n) Outpatient f/u recommended (n) Outpatient f/u completed (n) Received RT without outpatient RCS f/u (n)
Rad Onc 70% (45) N/A 43% (28) N/A
PT 92% (59) 63% (40) 9% (6) 22% (14)
OT 90% (58) 63% (40) 9% (6) 22% (14)
SLP 50% (32) 48% (30) 9% (6) 17% (11)
PMR 40% (26) 33% (21) 9% (6) 8% (5)
Table 1: Rates of RCS and RT in pts with HGG.

Conclusion: Despite high rates of documented need, few patients completed their recommended RCS follow up. This represents a potential area of quality improvement in our system. It suggests that additional multi-institutional studies are needed to determine the etiology and extent of RCS underutilization in patients with primary brain tumors. Since patients undergoing outpatient RCS did so during periods of radiation therapy, radiation oncologists may be uniquely poised to increase access to this important care.

Author Disclosure: S.C. Parke: None. J.M. Kneeman: None. N. Lam: None. L.M. Halasz: Research Grant; Fred Hutch/Univ of Washington Cancer Consortium. S.E. Day: None.

Samuel Day, MD, PhD

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