PD 16 - Lung 4 - Poster Discussion
1136 - Radiation Therapy Near End of Life in a Rapid Access Lung Cancer Clinic Compared to Standard Practice
Wednesday, October 24
11:06 AM - 11:12 AM
Location: Room 217 C/D
Ian Fraser, MBBS, FRCR
BC Cancer: Clinical Fellow: Employee; University of British Columbia: Clinical Fellow: Employee
Radiation Therapy Near End of Life in a Rapid Access Lung Cancer Clinic Compared to Standard Practice
I. M. Fraser1,2, R. A. Olson2,3, J. Regan2, M. R. McKenzie1,2, and S. Lefresne1,2; 1BC Cancer, Vancouver, BC, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3BC Cancer, Prince George, BC, Canada
Purpose/Objective(s): The Rapid Access Lung Cancer Clinic (RALCC) at our institution is designed to deliver palliative radiation therapy (RT) to patients with symptomatic newly diagnosed incurable lung cancer. Potentially eligible patients are triaged in advance, with CT simulation and RT appointments pre-booked to start on the same day as their initial consultation. As the result of a prior analysis in 2014 identified that 13% of patients received RT in the last 4 weeks of life, we hypothesized that RALCC patients may be more likely to receive RT near end of life due to the short time-frame for treatment decisions and the pre-booked same day treatment appointments. The purpose of this study was to compare RT utilization near end of life in RALCC to that in standard practice (SP).
Materials/Methods: Patient demographic and treatment factors were retrospectively collected from the electronic records for all patients assessed in RALCC between 1st January 2014 and 31st December 2015 and a SP cohort (all newly diagnosed stage IV lung cancer patients referred to a Radiation Oncologist at a neighboring cancer center during the same time period). Differences between RALCC and SP patient and treatment factors were compared using chi-square and t-tests for categorical and continuous variables respectively. Kaplan-Meier analysis was used for survival statistics.
Results: 187 patients were assessed in RALCC and 284 in SP. There were no significant differences between the two groups for gender, age, performance status, histology or number of lines of palliative chemotherapy. RALCC patients were more likely to receive RT following the initial consultation (93% vs 80%, p<0.001), start RT on the same day as the initial consultation (77% vs 7%, p<0.001) and receive single fraction RT as their longest course (18% vs 11%, p<0.05). Anatomic sites treated were also similar between RALCC and SP (chest 52% vs 61%, p=0.1; bone 44% vs 37%, p=0.2; brain 30% vs 29%, p=0.8). Median survival from consultation was 12 and 18 weeks for RALCC and SP respectively (p=0.4). There was no difference in receipt of RT within 4 weeks (15% vs 12%, p=0.4) or 2 weeks of death (5% vs 7%, p=0.4) for RALCC patients compared to SP. However, 12 patients in the SP cohort spent more than half of their remaining days receiving RT, compared to only 1 patient in RALCC (4.2% vs 0.5%, p=0.02) and RALCC patients were more likely to complete the intended course of RT (98% vs 93%, p=0.03).
Conclusion: Despite the short-time frame in which physicians have to make treatment decisions in RALCC, their patients are not more likely to receive RT in the last 4 weeks of life, but they are more likely to receive single fraction RT and spend less than half of their remaining days on treatment. This difference may be attributed to the multidisciplinary nature of RALCC, and the specialized interest in palliative care, which may influence methods of prognostication and choice in fractionation.
Author Disclosure: I.M. Fraser: None. R.A. Olson: Research Grant; Varian Medical Systems. J. Regan: None. M. McKenzie: Independent Contractor; BC Cancer. Member, Steering Committee, ARN-509 Trial; Janssen Research and Development.