Baseline Characteristics of Patients Undergoing Brachytherapy for Gynecologic Cancer (GYN-BT) and the Role for an Enhanced Recovery Pathway (ERP)

Abstract

<h3>Purpose/Objective(s)</h3> ERPs have been adopted by many surgical specialties and have demonstrated improved outcomes, including shorter hospital stay, decreased healthcare costs, improved time to functional recovery and patient satisfaction.¹ There is no current data evaluating ERP for patients undergoing brachytherapy. We plan to implement an ERP for patients with gynecologic malignancies, who will receive brachytherapy, with the goal to standardize and optimize the peri-operative phase and evaluate the impact on patient experience. <h3>Materials/Methods</h3> A single institution, prospective study evaluating the outcomes of patients undergoing GYN-BT before (33 patients) and after (33 patients) the implementation of an ERP. The ERP will include multidisciplinary interventions that span the pre-, intra-, and post-operative phases; including pre-habilitation, early referral to social work and psychiatric services, patient/caregiver education, pre-operative carbohydrate-loading, goal directed fluids, and opioid-sparing analgesia. Questionnaires to assess patient reported outcomes (PROs) at baseline, post-brachytherapy, and 60-day follow-up are collected. The EORTC QLQ-C30 consists of 30 items scored on a 4-point Likert scale and linearly transformed to a score, ranging from 0-100. Higher scores for functional scales and global health represent a favorable outcome, whereas a higher score for a symptom is unfavorable. A difference >10 was considered significant. <h3>Results</h3> Sixteen patients have been enrolled on study and completed baseline PRO questionnaires. Mean EORTC-QLQ-C30 global health score was 41.7, comparing unfavorably to the reference population of females with any cancer diagnosis²(59.3). Social functioning was worse (58.3) compared to the reference population (72.1), but there was no significant difference in physical, role, emotional or cognitive functioning. Additionally, this patient population had a significantly higher symptom burden, specifically fatigue (48.6 vs 37.7), nausea/vomiting (21.9vs 10.8), appetite loss (35.4 vs 23.8), and diarrhea (20.8 vs 9.3). Notably, mean score for financial difficulties was 45.8, more than double the reference value of 17.5. A significant proportion of patients described depression (56.3%), worry (68.8%) and interference with family life (62.5%). <h3>Conclusion</h3> Baseline data show that female patients with gynecologic malignancies represent a population with high-symptom burden and social stress. This data highlights the significant need for improved social support and multi-disciplinary care. We propose an ERP, with pre-habilitation and medical optimization, in combination with early referral to social work and psychiatric resources to standardize and improve care for this high-risk patient population.