Clinical Practice and Outcomes of Palliative Radiation Therapy in Pediatric Oncology Patients: An International Comparison of Experiences from Two Distinct Countries and Health Care Systems

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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Mindful congruence, four noble truths and healing relationships

International Journal of Whole Person Care ◽

10.26443/ijwpc.v5i1.159 ◽

2018 ◽

Vol 5 (1) ◽

Author(s):

Patricia Lynn Dobkin

Keyword(s):

Health Care ◽

Clinical Practice ◽

Compassion Fatigue ◽

Health Care Professionals ◽

Emotional Regulation ◽

Health Care Systems ◽

Buddhist Philosophy ◽

Healing Relationships ◽

Care Systems ◽

Four Noble Truths

Amidst the commotion of constant changes in health care systems, budget cuts, burnout and compassion fatigue there are resilient clinicians who relieve suffering and promote healing in those who seek their care. This workshop will focus on how doctors, nurses, and allied health care professionals serve in this way while maintaining equanimity and sense of meaning in their work and personal lives.This 90-minute experiential-based workshop will be divided into three parts.First, Mindful Clinical Practice will be described using narratives from different health care professionals in various settings. Mindful Congruence will be defined, along with Satir’s four other communication stances.Second, how the Four Noble Truths stemming from Buddhist philosophy inform clinical practice will be discussed with an emphasis on the Eightfold Path to end suffering. Third, a model of Healing Relationships (Scott et al, 2008; 2009) will be used to help participants identify underlying processes contributing to the relational outcomes: hope, trust, and being known. An Appreciative Inquiry exercise will be used to enrich participants’ understanding of their own experiences of being healers in clinical encounters.If and how medicine may be a spiritual practice will be examined.At the end of the workshop participants will be able to: 1. Define Mindful Congruence.2. Understand how the Four Noble Truths from Buddhist philosophy inform clinical practice.3. See how meditation practice contributes to clinicians’ mindfulness and emotional regulation.4. Discern the competencies and processes underlying healing.

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Clinical practice patterns for advanced breast cancer patients on CDK4/6 inhibitors receiving palliative radiation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.269 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 269-269

Author(s):

Neda Stjepanovic ◽

Sonal Gandhi ◽

William Tran ◽

Alia Thawer ◽

Ellen Warner

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Clinical Practice ◽

Advanced Breast Cancer ◽

Practice Patterns ◽

Advanced Breast ◽

Concurrent Administration ◽

Palliative Radiation ◽

Palliative Radiation Therapy

269 Background: Patients with hormone-receptor positive advanced breast cancer (ABC) often require palliative radiation therapy (RT) while receiving systemic treatment with CDK4/6 inhibitors (CDK4/6i). There are conflicting reports in the literature regarding whether concurrent administration of CDK4/6i and RT increases RT or hematologic toxicity and there are currently no formal guidelines for this realm. A Canadian national survey was conducted to evaluate local practice patterns of CDK4/6i management during palliative RT. Methods: An anonymized online survey was distributed to 162 Canadian breast cancer health care professionals between November 2020 and January 2021. The survey collected provider demographics and questions regarding practice, experiences and opinions on CDK4/6i management during palliative RT for ABC. Results: The survey was completed by 76 (47%) of the invited participants: 40% were medical oncologists, 26% radiation oncologists, 16% pharmacists and 18% nurses, physician assistants or radiation therapists. Nine provinces were represented. The respondents' clinical practice settings were predominantly at an academic/cancer centre (84%), while 16% of clinicians were based at a community setting. Interrupting the CDK4/6i during RT was recommended always by 21% of respondents, sometimes by 46% and never by 9%, while 24% had no opinion. The majority of opinions were based on personal experience (55%), colleagues’ practice (37%), medical literature (33%) and experience with chemotherapy agents (18%). Unexpected RT toxicity observed in patients on concomitant CDK4/6i was reported by 9% of respondents and prolonged cytopenias by 15%. Among responders who always or sometimes interrupt CDK4/6i during palliative RT, the timeframe to hold CDK4/6i prior to RT was 4-7 days 45%, 1-3 days 32%, 8-14 days 13% and 10% were unsure. Responses were similar for the timeframe used to resume the drug after RT. The majority (94%) thought that advising the patient on what to do with the CDK4/6i during RT was the role of the Medical Oncologist, while 48% also thought it was the role of the Radiation Oncologist. 23% of respondents though the patient should always be reassessed prior to restarting the CDK4/6i; 45% said sometimes, and 29% said not necessary. 82% of respondents indicated a standardized protocol or guideline would be valuable in this setting. Conclusions: Two thirds of Canadian breast cancer specialists sometimes or routinely interrupt CDK4/6i treatment during RT with 15% having observed increased toxicity with concurrent administration. Consensus guidelines for the management of CDK4/6i and RT are necessary to reduce treatment variability and improve the quality and safety of care for these patients.

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