Health Services Research
PV QA 3 - Poster Viewing Q&A 3
TU_40_2993 - Curative Intent Radiation Therapy Delivered Within the Last Year of Life
Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3
Lia Halasz, MD
University of Washington
Seattle Cancer Care Alliance: Associate Professor: Employee; University of Washington: Associate Professor: Employee
Abbvie: Research Grants; Fred Hutch/Univ of Washington Cancer Consortium: Research Grants
Curative Intent Radiation Therapy Delivered Within the Last Year of Life
Y. D. Tseng1, N. Gouwens2, L. M. Halasz1, S. S. Lo1, and E. Loggers3; 1University of Washington, Department of Radiation Oncology, Seattle, WA, 2Allen Institute for Brain Science, Seattle, WA, 3Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA
Purpose/Objective(s): Use of palliative radiotherapy (pRT) within the last year of life (LYOL) has been well-studied, but little is known about cancer patients that die within one year after curative-intent RT (cRT). Recently, we found that >25% cancer patients irradiated within the LYOL received cRT. Given the unexpectedly short survival, we hypothesized that many cRT patients likely had relapsed/refractory (R/R) disease at the time of RT or experienced treatment-related mortality (TRM), and we explored whether treatment intent influenced aggressiveness of care at the EOL, as measured by chemotherapy use and death in the ICU.
Materials/Methods: For patients regularly seen at a single institution that died between 10/1/2014 and 9/30/2015, we extracted and linked claims data and RT records, including treatment intent by the treating radiation oncologist. Chemotherapy use and death in the ICU were based on claims, scheduling, and clinical data. R/R disease was defined as history of prior disease with recurrence and/or persistent disease despite anti-cancer therapy. Cause of death was determined based on chart review.
Results: Among 870 cancer patients, 290 were irradiated within the LYOL. Of 287 with treatment intent recorded, 101 cRT and 186 pRT patients were irradiated at a median 169 and 102 days from death, respectively. cRT patients were younger (median 55 vs 62 years, p=0.04) with a slight male predominance (57.4%) and most frequently included patients undergoing transplant (27.7%) or with hematologic (16.8%; not undergoing transplant), head and neck (9.9%), gastrointestinal (9.9%), and sarcoma (8.9%) malignancies. Almost half (n=49, 48.5%) had R/R disease at the time of cRT; 12 had metastatic disease (11 diagnosed prior to cRT, 1 within 9 days after RT completion). The most common indications for cRT included TBI conditioning (40.8%), primary RT (32.0%), and adjuvant RT (19.4%). 11 of 103 cRT courses (10.7%) were not completed, most commonly due to intolerance of treatment. The most common cause of death was from tumor progression (n=65, 64.4%) followed by TRM (n=27, 26.7%), of which transplant and hematologic malignancy patients (n=19) made up the majority. There was no significant association between presence of R/R disease at cRT and cause of death (p=0.69). Compared with pRT patients, cRT patients had higher rates of chemotherapy use within 14 days of death (8.9% vs 2.7%, p=0.04) and ICU death (17.8% vs 3.8%, p=0.0001).
Conclusion: Cancer patients that receive curative-intent RT in the LYOL appear to be a heterogeneous population of patients that receive more aggressive care at the EOL compared to palliatively-irradiated patients. Additional studies are needed to understand how and why radiation oncologists categorize treatment as curative and whether designation of treatment as curative may influence subsequent therapies at the EOL, especially among subsets of patients with metastatic and/or R/R disease.
Author Disclosure: Y.D. Tseng: Employee; Allen Brain Science Institute. N. Gouwens: Employee; University of Washington. L.M. Halasz: Research Grant; Fred Hutch/Univ of Washington Cancer Consortium. S.S. Lo: Radiation oncology track chair; RSNA. President Elect; American Radium Society. E. Loggers: None.