Correlation of demographic factors with length of treatment and survival in a palliative radiation oncology population.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 123-123
Author(s):  
Lauren Michelle Hertan ◽  
Alexandra Nichipor ◽  
Yaseer Mohammed Khouj ◽  
Cierra Zaslowe-Dude ◽  
Tracy A. Balboni ◽  
...  
Keyword(s):  
Decision Making ◽  
Multivariate Analysis ◽  
Bone Metastases ◽  
Radiation Oncology ◽  
Background Radiation ◽  
Demographic Factors ◽  
Stereotactic Radiation Therapy ◽  
Stereotactic Radiation ◽  
Palliative Radiation ◽  
Length Of Treatment

123 Background: Radiation is often used to palliate symptoms in patients with advanced cancer and the number of fractions used can vary significantly from as short as a single fraction (SF) to up to a multiple week course. No data currently exists regarding demographic factors and their influence on survival and fractionation decisions. The aim of this project is to investigate the association of demographic factors with survival, likelihood of SF use in patients (pts) receiving RT for bone metastases, and likelihood of hypofractionation (HF) (≤ 5 fx) in pts being treated for any palliative reason, excluding those receiving partial brain RT (PBRT) which includes stereotactic radiosurgery, and stereotactic radiation therapy. Methods: We retrospectively reviewed charts of pts treated with palliative RT between 1/2015 – 5/2017 at 2 tertiary centers and 4 community satellite practices. Demographic factors analyzed are included in table 1. Logistic regression was used to evaluate the associations between the factors and outcomes. Results: A total of 928 pts were included in the survival analysis. In the two subset analyses, 373 pts were included in the bone metastasis analysis and 745 were included in the analysis of all patients excluding pts receiving PBRT. In pts treated for bone metastases, consult type (inpatient vs. outpatient) was the only significant factor on multivariate analysis, with inpatient consults being more likely to get SF (HR = 2.169, =.025). In the pts receiving palliative RT (excluding PBRT), race and consult location (tertiary vs. community) were significant. Non-white pts (HR=0.527, p=.012) and pts treated in the community (HR=.778, p<.001) were less likely to get HF. Gender (male vs. female), consult location (tertiary vs. community), and consult type (inpatient vs. outpatient) were significant on multivariate analysis for survival (HR=1.243, p=.028; HR=1.602, p<.001; HR=2.301, p<.001, respectively). Conclusions: This analysis suggests that demographic factors may affect both survival and decision making regarding fractionation in patients receiving palliative radiation. Further investigation into the reasons for these differences is needed.

Analysis of a neurosurgical directed acute spinal cord compression pathway at Michigan Medicine, a tertiary referral hospital.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18285-e18285
Author(s):  
John C. Krauss ◽  
Daniel Klarr
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Bone Metastases ◽  
Spinal Cord Compression ◽  
Radiation Oncology ◽  
Medical Oncology ◽  
Cord Compression ◽  
Imaging Protocol ◽  
Presenting Symptoms ◽  
Previous Diagnosis

e18285 Background: Spinal cord compression (SCC) is considered an oncologic emergency that is likely to severely impair patients’ quality of life if immediate action is not taken. Clinicians need a high suspicion to diagnose SCC, as the presenting symptoms are variable and nonspecific. To expedite the diagnosis and treatment of SCC, we instituted an emergent spine MRI imaging pathway that was led by the neurosurgeons and involved close collaboration with medical oncology and radiation oncology. Methods: The charts of all patients from July 2015 to June 2018 who underwent the “MR Spine Cord Compression Acute” imaging pathway at Michigan Medicine were reviewed. Electronic time stamps provided the time of the initial order, the time to scan completion, the time to scan reading, and the time to definitive intervention. The charts were reviewed for the initial neurosurgical physical exam, a presentation consistent with recent trauma, a previous diagnosis of malignancy, and a previous diagnosis of bone metastases. The type and timing of therapy, and survival following the imaging protocol were assessed. Results: 319 unique MRI exams were done over the three-year span, 155 of the patients had cancer, and 75 patients had SCC. The time from ordering of exam to performance is 2.91 hours (0 to 25.45), from performance to read 8.31 hours (0 to 75.25 hours). Time from MRI to intervention was 63.14 hours (0 to 432 hours) based on complex decision making around surgical vs. radiation vs. medical therapy. For the majority of patients who were diagnosed with SCC, the cause was secondary to tumor growth from contiguous spinal metastasis, and most had previously identified bone metastases. Degenerative disc extrusion was the most common cause of benign SCC. Conclusions: A neurosurgical directed standard imaging protocol is effective at rapidly diagnosing SCC. Malignant SCC is predominately treated surgically, but complex multi-disciplinary patient centered decision-making involving neurosurgery, radiation oncology, and medical oncology is frequently necessary to arrive at the appropriate treatment.

Development and implementation of a clinical pathway for radiation of bone metastases on a palliative radiation oncology service.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 170-170
Author(s):  
Lisa Rotenstein ◽  
Joseph Killoran ◽  
Tracy A. Balboni ◽  
Monica Shalini Krishnan ◽  
Allison Taylor ◽  
...  
Keyword(s):  
Decision Support ◽  
Bone Metastases ◽  
Nurse Practitioners ◽  
Clinical Pathway ◽  
Radiation Oncology ◽  
Treatment Guidelines ◽  
Clinical Pathways ◽  
Support Tool ◽  
Palliative Radiation ◽  
Oncology Service

170 Background: Clinical pathways increase compliance with treatment guidelines and reduce in-hospital complications. Evidence around treatment of complicated bone metastases is increasingly nuanced and although ASTRO/ACR recommend single fraction radiation therapy for uncomplicated bone metastases, implementation is variable. We sought to determine the effects of a bone metastases-focused clinical pathway on the practice patterns of our institution’s palliative radiation oncology service (SPRO), which sees 600 patients yearly and on a rotating basis, involves 23 physicians, 28 residents, 2 nurse practitioners, and 1 fellow. We hypothesized that pathway implementation would augment data-driven use of palliative radiation for bone metastases, including use of 8 Gy x 1 for uncomplicated metastases. It would also enhance physician efficiency and confidence. Methods: Using published literature, clinical guidelines, and expert input, we designed a comprehensive clinical pathway for bone metastases radiation. This was translated to a secure electronic interface as a decision support tool and integrated into daily SPRO workflows. Providers were surveyed pre and post implementation to assess expectations and elicit feedback. Rates of pathway compliance and reasons for non-compliance were assessed. Rates of 8 Gy x 1 use for uncomplicated metastases were compared pre and post implementation. Our aim was for approximately 70-80% on-pathway rates. Results: The final pathway, which includes twenty endpoints, integrates several validated scoring systems, including assessments of life expectancy, spinal stability, and appropriateness of surgical management. The pathway has been well received on the SPRO service, with addition of extra steps to workflows being the main cause of resistance to use. Data on rates of pathway adherence will be reported, and rates of 8 Gy x 1 use will be compared to the baseline of 22%. Conclusions: Our experience suggests the utility of pathways-based decision support for bone metastases radiation on a palliation consult service. Next steps include assessing the pathway’s effects on guideline-concordant care and calculating associated cost savings.

Propensity score matched analysis of a palliative radiation oncology consult service’s impact on length of stay and total costs during hospitalization.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 162-162
Author(s):  
Sanders Chang ◽  
Peter May ◽  
Nathan Goldstein ◽  
Doran Ricks ◽  
Kenneth Rosenzweig ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Propensity Score ◽  
Bone Metastases ◽  
Radiation Oncology ◽  
Hospital Cost ◽  
Total Hospital Cost ◽  
Service Model ◽  
Advanced Cancer Patients ◽  
Total Hospital ◽  
Palliative Radiation

162 Background: The Palliative Radiation Oncology Consult Service (PROC) was a clinical service model developed in 2013 at Mount Sinai Hospital to provide individualized, goal-directed treatment to advanced cancer patients requiring palliative radiation therapy (PRT). We assessed its impact on length of stay (LOS) and total costs incurred during a hospitalization among patients who underwent PRT for symptomatic bone metastases while in the hospital. Methods: In our observational cohort study, we identified patients who underwent their first PRT course for bone metastases during a hospitalization between 2/2010 and 12/2016. Total costs (direct and indirect costs) during the hospitalization were extracted from the institution’s cost accounting system. Propensity score matching (PSM) was performed against age, Charlson comorbidity index (CCI), gender, race, primary cancer, and health insurance status. Balance across groups was verified by standardized differences before and after PSM. Average treatment effects (ATE) of hospital costs and LOS were calculated from generalized linear models with a γ distribution and log link adjusted by propensity score weights. PRT patients treated before 2013 (before PROC was established) were compared to those treated after 2013 (after PROC was established). Results: In total, 181 patients were included, with 76 treated before and 105 treated after PROC. Before propensity score matching, patients treated prior to PROC’s establishment had a median total hospital cost of $72,787 (range, $5,981-$324,652) and a median LOS of 28 days (range, 2-105); whereas patients treated after PROC had a median total hospital cost of $49,950 ($7,585-$620,943) and a median LOS of 19 days (2-139). After matching, patients had an ATE of -$16,877 total hospital cost (95% CI [-33,250,-504], p = 0.043) and -8.5 days in LOS (95% CI [-13.9,-3.2], p = 0.002). Conclusions: PROC, a clinical service model that integrated principles of palliative care practice within radiation delivery, led to substantial cost-savings and shorter lengths of stay for advanced cancer patients requiring PRT for bone metastases during a hospitalization.

Do case rates affect physicians' clinical practice in radiation oncology?

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 59-59
Author(s):  
Bryan A. Loy ◽  
Clive Shkedy ◽  
Mark A. Tankersley ◽  
Brian Altonen ◽  
Julie Royalty
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Bone Metastases ◽  
Radiation Oncology ◽  
Background Radiation ◽  
Cancer Type ◽  
Health Plans ◽  
Fee For Service ◽  
Target Ratio ◽  
Case Rate

59 Background: Radiation oncology practices and health plans typically engage in fee for service (FFS) contractual relationships, which employ utilization management techniques to manage treatment accordance with recognized guidelines. FFS contracts often result in unpredictable revenue streams for practices and burdensome administrative processes for both practices and payers. Moreover, there are limited mechanisms in FFS arrangements for practices and payers to systematically measure quality. Radiation oncologists and health plans share the common goal of systematically improving quality of patient care while reducing administrative burden. Methods: In 2012, Humana collaborated with a large national radiation therapy provider to implement ‘bundled’ case rate reimbursement instead of FFS. The case rate model was developed with HealthHelp, a radiation oncology quality vendor, and the payments were developed in the context of the appropriate modality for each cancer type. Changes in practice patterns were measured in the Medicare population by average fraction ratios across breast cancer, bone metastases, and prostate cancer. Fraction ratios compare delivered fractions to standards established by the National Comprehensive Cancer Care Network guidelines. A ratio of 1.0 means that the delivered amount met the recommended guideline. Ratios nearer to one (over or under) demonstrate appropriate therapy. Ratios were compared for 2011 vs. 2013 using T-tests. Results: Conversion from a FFS to case rate reimbursement did not coincide with a change in fraction ratios for breast cancer treatment. Fraction ratios for both bone metastases and prostate cancer moved towards the target ratio of 1.0 after the move to case rate reimbursement. Conclusions: After the implementation of case rate reimbursement, fraction ratios improved for bone metastases and prostate cancer, while breast cancer fraction ratios did not change. Future work will evaluate additional markers of quality and practice efficiency measurements. [Table: see text]

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