Efficiency of Radiotherapy Delivery for Patients With Breast Cancer in a Dedicated Multidisciplinary Palliation Radiation Oncology Clinic

Abstract

At least half of patients who die of cancer suffer from symptoms that adversely affect quality of life, many of which are amenable to palliative radiotherapy (PRT). In this population, urgent assessment and PRT initiation can be beneficial. At our institution, patients requiring PRT can be assessed in multiple settings, including through a dedicated multidisciplinary Palliative Radiation Oncology (PRO) clinic. We examined the logistics of PRT delivery by consultation setting.This secondary analysis of routinely collected data examined adult female patients with breast cancer who died between 04/01/2013 and 03/31/2014, after at least one course of PRT. During this period, setting and timing of PRT consultation was at the attending physicians' discretion. Patient- and treatment-related data were abstracted including timelines of consultation, simulation (sim), treatment start and PRT completion. Descriptive statistics along with independent t-tests and Chi-square tests were calculated.65/121 patients had one course of PRT, 33 had two, and 23 had three or more, with on average 1.3 sites treated per course. 27/215 (12.5%) consults took place in the PRO clinic while 166/215 (77.2%) occurred in the on-treatment review clinic. Average interval from referral to consult, consult to sim, and sim to start for PRO visits were 4.7 days, 0 days and 1.8 days respectively; for non-PRO visits, intervals were 4.8 days (P = 0.95), 1.3 days (P = 0.42) and 4.8 days (P = 0.008), respectively. Same day sim occurred in 100% of PRO visits versus 86.2% (162/188) of non PRO visits (P = 0.052). Same day PRT start occurred in 37% of PRO visits versus 23.4% of non-PRO visits (P = 0.13). 44% (11/25) of PRT courses for bone metastases prescribed after PRO visits were single fraction versus 25.6% (46/180) after non-PRO. There were no significant differences in rate of completion of prescribed PRT (100% after PRO vs 98.4% after non-PRO consults) or completion within 14 days of death (3.7% after PRO vs 5.3% after non-PRO).Consultation utilizing dedicated established PRO clinic infrastructure facilitates efficacious PRT delivery.