Retrospective Review of Follow-Up Strategies for Patients Receiving Palliative Radiotherapy

Abstract

<h3>Purpose/Objective(s)</h3> There is no current standard-of-care follow-up strategy for patients who receive palliative radiotherapy (PRT) for bone metastases. Within our institution some providers schedule routine follow-up appointments while others only have follow-up as needed (PRN) following a course of PRT. Our study aims to evaluate whether provider follow up strategy correlates with measurable differences in overall quality of care (QoC). We hypothesize that having a routine follow-up appointment following a course of PRT correlates with improved QoC through improved identification of patients who would benefit from additional treatment. <h3>Materials/Methods</h3> Through retrospective chart review, we identified patients who received PRT for bone metastases at our single institution. Inclusion criteria consisted of age ≥ 18 years at the time of treatment and initial PRT course between July 2020 and June 2021. Patients with bone metastases were identified by ICD-10 codes, radiation course name, and PRT dose. Brain and other non-bone metastases were excluded. Demographic, clinical, and PRT data, and time to retreatment were collected and analyzed via descriptive statistics. Follow-up strategies for PRT patients were identified among 17 radiation oncologists. Differences in rate of retreatment were assessed via Fishers exact test. <h3>Results</h3> A total of 378 unique PRT courses were included in our study. PRT courses were divided into separate cohorts based on having scheduled follow-up post treatment (n=160, 42.3%) vs PRN follow up (n=218, 57.7%). The average patient was 64 years old at the time of treatment in both groups. The most common malignancies were breast (n=80, 21%), prostate (n=78, 20.6%), and lung (n=41, 10.8%) with similar proportions in each group. 191 (50.5%) courses included spinal metastases and 187 (49.5%) included non-spine bone metastases with no significant differences between cohorts. Among the scheduled follow-up cohort, more patients (n=65, 40%) received additional treatment within the following year as either retreatment of the initial site or treatment of new sites of pain when compared to the PRN follow up cohort (n=38, 17%). Patients with scheduled follow up had a shorter median time to retreatment of 103 days vs 142 days in the PRN follow up group. <h3>Conclusion</h3> In our retrospective study, we found that having at least one routine follow up for patients receiving PRT led to higher rates of additional treatment with PRT (40% vs 17%, p<0.01) and a shorter median time to retreatment (103 days vs 142 days). Our study shows potential improvement in the QoC for patients receiving PRT through better identification of patients in need of additional PRT. We acknowledge several limitations to this retrospective analysis including primarily the risk of selection bias which we intend to further explore on subsequent analysis. Our results may serve as a clinical basis to suggest a routine 1–3 month follow up after a course of PRT for bone metastases.