Abstract A133: Comparison of radiation therapy initiation timelines among varied referral streams to identify sources of delay

Abstract

Abstract Purpose/Objective(s): Tertiary radiation oncology centers receive referrals from diverse care settings, including private facilities, Veteran’s Affair (VA) hospitals, and county hospitals. An exploratory study of county patients treated at our institution identified that each missed consult or simulation (sim) appointment was associated with a greater than three-week delay from referral to radiation (RT) start. We sought to validate this in a larger sample and compared RT referral-to-start timelines for a variety of referral streams. Materials and Methods: Up to 60 consecutively referred patients from each facility (internal health system, VA, county hospital, and external private facilities) between June to December 2018 were included. Primary disease site, interpreter requirements, and dates of referral, consultation, sim, and RT start were recorded. Linear regression and analysis of variance models were developed to identify variables associated with delays in RT. Results: Of 214 patients were included; 55 (26%) internal, 53 (25%) from the VA, 60 (29%) from the county hospital, and 46 (22%) from other facilities. Among the 33 patients requiring interpreters, 28 (85%) were county patients. The most common referrals were for genitourinary (GU) cancers (n = 63, 29%), followed by breast (n = 29, 14%), lung (n = 26, 12%), and head and neck (n = 21, 10%) cancers. The median days from referral to consult was 16 (IQR 7-28), with the shortest time to consult for bone (1.5 days, IQR 1-5) and central nervous system sites (5 days, IQR 3-9) and the longest for gynecologic cancers (21.5 days, IQR 8.5-44). Excluding GU patients, who often require two months of neoadjuvant hormone therapy prior to RT, the median days from consult to sim was 13 (IQR 6-20) with no significant differences in referral to consult or consult to sim by referring facility. In all patients, the median days from sim to RT start was 8 (IQR 6-14) with no significant differences by referral facility. In univariate analysis among non-GU patients, referring facility and requirement of an interpreter were not associated with referral-to-start delays; only missing one or more consult/sim appointments was significant (p < 0.001). Each missed appointment was associated with a 37-day delay (95% CI 26 – 48) in referral-to-start. Conclusion: In a patient cohort with heterogeneous cancer diagnoses, no facility-specific delays were identified despite county hospital patients having known socioeconomic vulnerability. Efforts to decrease RT delays may require department-wide, as opposed to interfacility, interventions. Future goals involve using site-specific referral-to-start benchmarks (e.g. one week for palliation and 10 weeks for GU) to further discriminate differences. Citation Format: Melody J Xu, Sumi Sinha, Sunny Wang, Terence Friedlander, Steve E Braunstein. Comparison of radiation therapy initiation timelines among varied referral streams to identify sources of delay [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A133.