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

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.

Lia Halasz, MD

University of Washington

Disclosure:
Employment
Seattle Cancer Care Alliance: Associate Professor: Employee; University of Washington: Associate Professor: Employee

Compensation
Abbvie: Research Grants; Fred Hutch/Univ of Washington Cancer Consortium: Research Grants

Biography:
Dr. Lia M. Halasz is an Associate Professor of Radiation Oncology and Neurological Surgery at the University of Washington in Seattle, Washington. She earned her medical degree and completed residency at Harvard Medical School in Boston, Massachusetts. Her clinical interests include caring for patients with central nervous system tumors including primary brain and spinal cord tumors and metastatic disease. She has particular expertise in proton therapy and stereotactic radiosurgery.

She is the Radiation Oncology Residency Program Director at the University of Washington and the Radiation Oncology Lead for the Alvord Brain Tumor Center. She serves as a CNS Associate Editor for the International Journal of Radiation Oncology Biology Physics and Chair of the Health Services Scientific Committee for the American Society for Radiation Oncology (ASTRO).

Her research interests include the adoption and comparative effectiveness of new radiation technologies as well as the treatment of CNS tumors with proton therapy.

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