Modern Palliative Radiation Treatment: Do Process Improvements Reduce Medical Errors?

In this case report, radiation therapy was performed for bilateral hydronephrosis developed during multiple bone metastases of breast cancer and ileus due to peritoneal dissemination. The patient’s preirradiation creatinine level was 8.2 mg/dL, which decreased by the fourth day after starting irradiation therapy. Creatinine level ultimately decreased to 0.6 mg/dL. Pain due to lumbar spine metastasis alleviated and ileus was resolved, allowing the patient to live at home for approximately 5 weeks. The effect of radiotherapy for bilateral hydronephrosis and gastrointestinal obstruction was rapid and good. Palliative radiation treatment can be used for multiple purposes, and in the present patient, we were able to prolong the vital prognosis.

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Longitudinal trends in costs for palliative radiation for metastatic prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.6554 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 6554-6554

Author(s):

Timothy J Robinson ◽

Michaela A Dinan ◽

Yanhong Li ◽

Robert Lee ◽

Shelby D. Reed

Keyword(s):

Prostate Cancer ◽

Health Care ◽

Radiation Therapy ◽

End Of Life ◽

Metastatic Prostate Cancer ◽

Radiation Treatment ◽

Inclusion Criteria ◽

Palliative Radiation ◽

Palliative Radiation Therapy ◽

Bony Metastases

6554 Background: Prostate cancer is a leading contributor to cancer health care costs, with end of life care composing a substantial portion of overall costs. In recent years, palliative treatment of metastases has been characterized by the use of more complex radiation planning and delivery systems. However, little is known about how costs of palliative radiation treatment in patients with metastatic prostate cancer have changed over this period. Methods: Retrospective analysis of SEER-Medicare data of men aged 66 and older who died from metastatic prostate cancer between 2000 and 2007. Inclusion criteria included all fee-for-service beneficiaries treated with radiation therapy for bony metastases in the last year of life. Direct costs were obtained by summing Medicare carrier and outpatient facility payments for all radiation treatment claims following an initial radiation treatment claim for bony metastases and adjusted to 2008 dollars using Consumer Price Indexes for medical care. Results: A total of 1,705 men met study inclusion criteria. Median age at diagnosis was 74, median time from diagnosis to death was 47 months, and 37% of men had distant metastatic disease at the time of diagnosis. Total Medicare payments for radiation therapy for bony metastases increased from an average of $2,763 to $3,989 for men who died from prostate cancer in 2000 vs. 2007. Outpatient facility claims for radiation therapy increased relative to carrier claims, composing 48% ($1,316) and 57% ($2,276) of all radiation treatment Medicare payments in 2000 vs. 2007 (All P < 0.001). Conclusions: Between 2000 and 2007, average Medicare payments for palliative radiation therapy for bony prostate cancer metastases increased by roughly a third. The majority of increased costs were observed within outpatient facility claims, suggesting a shift in the administration of palliative radiation therapy from free-standing clinics to hospital-based outpatient facilities. Changes in end of life palliative radiation therapy for men with prostate cancer may impact future increases in Medicare health care expenditures.

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The cost implications of palliative radiation therapy dose and fractionation for painful metastatic bone lesions.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.34_suppl.145 ◽

2018 ◽

Vol 36 (34_suppl) ◽

pp. 145-145

Author(s):

Mark Raymond Waddle ◽

Tasneem Kaleem ◽

William C Stross ◽

Timothy D Malouff ◽

Mikayla Jenkins ◽

...

Keyword(s):

Mayo Clinic ◽

Radiation Treatment ◽

Bone Lesions ◽

Palliative Radiation ◽

Costs Of Care ◽

Palliative Radiation Therapy ◽

Breast And Prostate Cancer ◽

Cost Implications ◽

The Cost ◽

Fractionation Schedules

145 Background: Palliative radiation treatment (pRT) is used for symptomatic bone metastases (mets). Several fractionation schedules show equal efficacy for pain relief, and ASTRO’s Choosing Wisely recommends 8Gy x1, 4Gy x5, or 3Gy x10. This study aims to investigate the cost implications of pRT for bone mets. Methods: Patients (Pts) treated with pRT for bone mets at Mayo Clinic from 2007 - 2016 were included in this study. Costs for all services were subdivided into RT and total costs at 30 & 90 days (30D & 90D). Standardized costs were obtained from the Mayo Clinic Cost Data Warehouse and Medicare reimbursements were assigned to all services with cost to charge adjustments and 2017 GDP Implicit Price Deflator for inflation. Cost means were compared via the Kruskal-Wallis test. Results: 538 pts were treated with pRT, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Pts with breast and prostate cancer were most likely to be treated with 3Gy x10 and pts with GI and lung cancer were most likely to be treated with 8Gy x1. RT costs at 30D were $1,497, $1,891, and $1,982 (p=0.03) and RT costs at 90D were $2,602, $2,753, and $3,032 (p=0.08) for initial RT regimens of 8Gy x1, 4Gy x5, and 3Gy x10. Total costs of care at 30D were similar from $15,969 - 17,687 (p=0.6) and total costs at 90D were similar from $22,361 - 23,219 (p=0.7) between arms. A total of 23%, 28%, and 39% of pts were alive 2 years following pRT from each arm (p=0.07). Conclusions: This is the first study of its kind to analyze actual treatment costs for the three most common pRT regimens in bone mets. Single fraction RT was most used for pts with poor prognoses and was associated with lower RT costs at 30D, but similar RT costs at 90D, possibly due to retreatment. RT choice had no impact on overall costs of care at 30D or 90D. pRT remains of high value, representing only 11-13% of total costs.[Table: see text]

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Use of a rapid access multidisciplinary bone metastases clinic to decrease financial toxicity for patients undergoing single-fraction palliative radiation.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.24 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 24-24

Author(s):

Jose Alberto Maldonado ◽

Minsoo Kim ◽

Prasamsa Pandey ◽

Sarah Todd ◽

Kaitlin Marie Christopherson ◽

...

Keyword(s):

Bone Metastases ◽

Radiation Treatment ◽

Travel Distance ◽

Cancer Center ◽

Cost Burden ◽

Financial Toxicity ◽

Single Fraction ◽

Palliative Radiation ◽

Rapid Access ◽

Significant Difference

24 Background: A rapid access bone metastases clinic (RABC) was instituted at MD Anderson Cancer Center (MDACC) to allow outpatient consult, simulation and radiation treatment (RT) initiation in < 6 hours for patients with painful bone metastases. Patients underwent multidisciplinary evaluation with orthopedics and radiation oncology. One aspect of financial toxicity is distress due to out-of-pocket (OOP) cost associated with a treatment. We hypothesized the RABC would decrease financial toxicity for MDACC patients over traditional RT. Methods: RABC patients surveyed between April 2018 and January 2020 were included. Patients were asked to estimate OOP cost for RT (including travel and treatment cost) and perceived cost burden of treatment. Travel distance was hometown distance to MDACC. Subset analyses were performed for patients receiving single fraction (1fx) and 2-5 fractions (2-5fx). Estimated OOP cost (1fx: RABCN= 34, nonRABCN= 20; 2-5fx: RABCN= 4, nonRABCN= 22), perceived cost burden (1fx: RABCN= 32, nonRABCN= 27; 2-5fx: RABCN= 7, nonRABCN= 38) and travel distance (1fx: RABCN= 34, nonRABCN= 28; 2-5fx: RABCN= 7, nonRABCN= 38) were compared using a Mann-Whitney U Test. Travel distance was also compared to OOP cost. Patients treated with 6+ fractions were excluded. Results: Median estimated OOP cost was significantly lower for 1fx RABC patients vs. 1fx non-RABC patients ($450 [IQR $187.5-$1,050] vs. $2,000 [$625-$4,000]; p = 0.008), but there was no significant difference for 2-5fx ($1,900 vs. $1,375; p = 0.593). Overall patient satisfaction with cost burden was high regardless of treatment setting (1fx: 10 [8-10]; 2-5fx: 10 [8-10]). Median travel distance was not significantly different between clinics (1fx: 245 [39.8-351.5] vs. 262.5 [83-879.3], p = 0.3651; 2-5fx: 274 [36-1293] vs. 176 [25-626], p = 0.2721). Travel distance was directly correlated with out of pocket cost for single fraction (1fx: R2= 0.125, p = 0.0109; 2-5fx: R2= 0.037, p = 0.3433). Conclusions: The establishment of a RABC at MDACC significantly decreased financial toxicity for 1fx patients receiving palliative RT, but not in the 2-5fx cohort. Increased financial toxicity was associated with longer travel distance for 1fx palliative radiation. Implementation of a similar model in local community centers may decrease financial toxicity for patients receiving palliative radiation.

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Performance status versus anatomical recovery in metastatic disease: The role of palliative radiation treatment

International Journal of Surgery ◽

10.1016/j.ijsu.2016.06.019 ◽

2016 ◽

Vol 33 ◽

pp. S126-S131 ◽

Cited By ~ 3

Author(s):

Alfonso Reginelli ◽

Giustino Silvestro ◽

Giovanni Fontanella ◽

Angelo Sangiovanni ◽

Mario Conte ◽

...

Keyword(s):

Metastatic Disease ◽

Radiation Treatment ◽

Performance Status ◽

Palliative Radiation

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Developing clinical indicators to effectively monitor a large network of radiation oncology practices.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.236 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 236-236

Author(s):

Seth D. Frey ◽

Karen E. Hoffman ◽

Anuja Jhingran ◽

Mary Frances McAleer ◽

Bruce D. Minsky ◽

...

Keyword(s):

Radiation Oncology ◽

Radiation Treatment ◽

Performance Indicator ◽

First Year ◽

Large Network ◽

Clinical Indicators ◽

Process Improvements ◽

Monitoring Process ◽

Md Anderson ◽

Effective Radiation

236 Background: The MD Anderson Cancer Network includes 29 distinct Radiation Oncology facilities spread across metropolitan Houston area locations, national partnerships, and international affiliates. Standard performance indicators (PIs) were developed to monitor the quality and safety of radiation treatment at these facilities spread across the globe. Methods: Stakeholders from Radiation Oncology nursing, dosimetry, physics, radiation therapy, and clinical operations identified PIs that measure safe, efficient, and effective radiation oncology care. PIs are collected monthly from each facility and are reported in a scorecard that includes performance goals. The appropriateness and effectiveness of the PIs are reviewed annually to determine if PIs need to be added, removed, or revised. Results: As the network expanded, scorecard use expanded from 11 facilities in 2013 to 29 facilities in 2019. Select PIs are summarized in the table. Scorecard composition has evolved over time. PIs such as completion of simulation orders and treatment planning directives were removed once consistently reaching 100% after improved monitoring, process improvements, and implementation of hard stops. The scorecard has been especially useful when onboarding new facilities, as evidenced by PIs increasingly meeting performance thresholds in the first year after joining the network. For example, one facility increased PI compliance from 61% to 100% the first year after joining the network. Conclusions: It is feasible to develop and implement a performance indicator scorecard across a large radiation oncology network. The scorecard permits timely assessment of quality indicators, provides oversight, and is effective in stabilizing operations at newly on-boarded radiation oncology practices. [Table: see text]

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