Abstract
Treatment interruptions are an infrequently studied topic in radiation therapy (RT). Minimizing interruptions is essential, as prolonged treatment courses predict for persistent regional disease and decreased overall survival. To our knowledge, treatment interruptions have not yet been examined in patients receiving palliative radiation. Finding ways to predict for interruptions in this population can allow for increased treatment tolerance through methods such as hypofractionation. Karnofsky Performance Status (KPS) is a frequently used tool to quantify the functional status of cancer patients. However, its use in predicting palliative radiation treatment interruptions is unknown. This study investigated whether KPS, comorbidity, treatment location, or socioeconomic status (SES) are predictive of treatment interruptions in an ethnically diverse population. This retrospective study included patients who received palliative radiation to the brain, spine, or bone between January 1st, 2016 and June 30th, 2016. Patients were treated either at a private academic hospital (PAH) or an adjacent safety-net hospital (SNH). Variables analyzed included treatment location, gender, socioeconomic status (SES), age, comorbidity (ACE-27 comorbidity index), and KPS score (stratified into good, fair, or poor). Patients were classified as having a major treatment interruption if they missed ≥ 2 treatments or ended RT prematurely. Univariable (UVA) and multivariable analyses (MVA) were performed by using the logistics regression model. Odds ratios (ORs) were estimated along with corresponding 95% confidence intervals and p-values. All p-values were two-sided. 124 patients were included in this study. 65.3% of patients were treated with palliative RT to the spine or bone, and 34.7% of patients were treated to the brain. 81.5% of patients were treated at the private academic hospital and 18.5% were treated at the safety-net hospital. 31.5% of patients had a good KPS score, 50.8% of patients had a fair KPS score, and 17.7% of patients had a poor KPS score. 12.9% of patients had a major treatment interruption. 73.4% of patients were classified as having low comorbidity, and 26.6% of patients were classified as having high comorbidity. On UVA, increased likelihood of a major treatment interruption was associated with high vs. low comorbidity (OR 3.32, p = 0.03) and fair (OR 8.04, p = 0.05) or poor (OR 8.44, p = 0.06) vs. good KPS score. Treatment location (PAH vs. SNH), location of metastasis treated (brain vs. spine/bone), socioeconomic status, and age had no impact on major treatment interruptions. There is a paucity of literature that discusses palliative radiation treatment interruptions. In this study, comorbidity and functional status are both predictive of major treatment interruptions. Consideration of hypofractionation techniques in patients with high comorbidity or low functional status is warranted.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call