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

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.

scholarly journals Rapid Access Multidisciplinary Bone Metastases Clinic Decreases Financial Toxicity for Patients Undergoing Palliative Radiation

2019 ◽  
Vol 105 (1) ◽  
pp. S47-S48
Author(s):  
J.A. Maldonado ◽  
L.E. Colbert ◽  
M.M. Gomez ◽  
S.E. Todd ◽  
K.M. Christopherson ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Financial Toxicity ◽  
Palliative Radiation ◽  
Rapid Access

Toxicity following palliative radiation therapy for painful metastatic bone lesions.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 126-126 ◽  
Author(s):  
Mikayla Jenkins ◽  
Mark Raymond Waddle ◽  
Tasneem Kaleem ◽  
William C Stross ◽  
Timothy D Malouff ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Radiation Treatment ◽  
Performance Status ◽  
Poor Performance ◽  
Patient Characteristics ◽  
Bone Lesions ◽  
Poor Performance Status ◽  
Financial Toxicity ◽  
Palliative Radiation ◽  
Ed Visits

126 Background: Palliative radiation treatment (pRT) is a common and effective treatment for patients with symptomatic bone metastases. However, patients receiving RT for bone metastases often may have a poor performance status and are more likely to experience toxicity during or after treatment. This study aims to investigate the number and type of toxicity event occurring during or after pRT for bone metastases. Methods: Patients treated with RT for bone metastases at Mayo Clinic from 2007 to 2016 were included in this study. Demographic, disease, treatment, and toxicity information were collected. Specifically, toxicity events were identified as emergency department (ED) visits and inpatient hospitalization (IH) within 90 days, breaks in treatment >4 days, and excessive 30 day financial toxicity defined as standardized Medicare costs >1 standard deviation above the mean. RT treatment was compared by dose and fractionation via descriptive statistics. Results: A total of 538 patients treated with pRT were identified, 124 receiving 8Gy x1, 204 receiving 4Gy x5, and 210 receiving 3Gy x10. Patients with breast and prostate cancer were most likely to be treated with 3Gy x10 and patients with GI and Lung cancer were most likely to be treated with 8Gy x1. A description of the patient characteristics and toxicities are shown in Table 1. For 8Gy x1, 4Gy x5, and 3Gy x10 breaks in treatment were rare (0%, 2%, and 3.3%), ED visits (15%, 24%, & 28%), IH (12%, 23%, & 19%), and financial toxicity (13%, 18%, & 21%) were common. A total of 22.6%, 27.5%, and 38.6% of patients were alive two years following pRT from each group. Conclusions: Toxicity during or shortly after pRT of bone metastases is common. This study confirms that additional steps should be taken to monitor and mitigate toxicity in this vulnerable patient group. [Table: see text]

Single-Fraction Radiation Treatment for Uncomplicated Bone Metastases #335

2017 ◽  
Vol 20 (9) ◽  
pp. 1032-1033
Author(s):  
Shayna E. Rich ◽  
Candice Johnstone
Keyword(s):  
Bone Metastases ◽  
Radiation Treatment ◽  
Single Fraction

scholarly journals Single fraction radiotherapy is more acceptable than multi-fraction radiotherapy to palliate the metastatic bone pain

2017 ◽  
Vol 45 (3) ◽  
pp. 151-155
Author(s):  
Sadia Sharmin ◽  
Md Zillur Rahman Bhuiyan ◽  
Atiar Rahman ◽  
Sarwar Alam
Keyword(s):  
Pain Relief ◽  
Bone Pain ◽  
Radiation Treatment ◽  
Symptom Relief ◽  
Complete Response ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Single Fraction ◽  
Significant Difference ◽  
Metastatic Bone Pain

One of the main goals of palliative radiation treatment is the relief of pain or dysfunction caused by the bone metastasis. Most patients achieve pain relief after irradiation. The striking clinical observation is that some patients experience symptom relief within 24hrs after the irradiation. This quasi experimental study was carried out in the department of Oncology, BSMMU from January 2014 to June 2014 with the intention to compare the role of single fraction and multiple fraction radiotherapy in the management of bone secondaries as regard as potency for pain relief. A total of 100 patients with age up to 70 years and of any sex having cytologically or histologically proven malignant diseases with the painful bone metastases in single or multiple sites without pathological fracture were selected for the study. They had no history of previous radiotherapy on the treatment site. Patients were divided in to two Arm A and Arm B with 50 patients in each arm. Arm A was treated with single (8 Gy) fraction radiotherapy and Arm B was treated with multiple fraction (30 Gy) radiotherapy i.e. 300 cGy per fraction in 10 fractions, 5 days a week for two weeks by telecobalt or orthovoltage machine. 44 patients in Arm A & 46 patients in Arm B completed the study. Onset of pain relief after completion of 4th week radiation were 68% in Arm A and 67.4% in Arm B . It was observed that, after 8th week of radiation 81.8% in Arm A and 86% in Arm B were relieved from pain. According to histological typing, 45% in Arm A & 52% patients in Arm B had complete response; 40% in Arm A & 37% patients in Arm B had partial response and overall distribution of no response of patient in Arm A was 18% and in Arm B was 7%. Metastatic bone pain represents one of the major indications in the external beam radiation therapy today.The disease can be efficiently treated by the use of either single fraction or multifraction radiotherapy without any significant difference in response to rate and early toxicities.Bangladesh Med J. 2016 Sep; 45 (3): 151-155

scholarly journals Considerations for quality improvement in radiation oncology therapy for patients with uncomplicated painful bone metastases.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 118-118
Author(s):  
Anne M. Walling ◽  
Neil Wenger ◽  
Tania Betty Kaprealian ◽  
Patrick Kupelian ◽  
Susan Ann McCloskey ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Bone Metastases ◽  
Radiation Oncology ◽  
Travel Distance ◽  
Tumor Control ◽  
Prognostic Information ◽  
Single Fraction ◽  
Radiation Oncologists ◽  
Painful Bone Metastases ◽  
Clinical Cases

118 Background: Although American Society for Radiation Oncology (ASTRO) guidelines support single fraction radiation treatment for uncomplicated bone metastases, it is rarely used. Methods: We used modified RAND/UCLA appropriateness methodology to understand how radiation oncologists make decisions about single fraction treatment to inform quality improvement. We focused on uncomplicated bone metastases (defined by relevant RCT exclusion criteria) without prior irradiation, pathologic fracture, or spinal cord compression. Eight radiation oncologists with varying sub-specialties were provided ASTRO guidelines, a summary table of RCT’s and recent research on current practices. They rated the appropriateness of 8Gy Single Fraction treatment and 4 alternative regimens for clinical cases before and after a panel discussion that also included three palliative care physicians. Clinical cases varied by location of metastases (spine, humeral head, femur, rib), size of metastases, patient prognosis, travel distance to treatment site, and patient age. We report findings based on final median appropriateness ratings and qualitative evaluation of discussion. Results: Single fraction treatment (8Gy) was rated as the most appropriate treatment, regardless of other factors if prognosis was 6 months or less. However, participants noted that prognostic information is often not available at the point of care. Use of greater than 10 fractions was rated as inappropriate regardless of other factors. Older age and travel distance were factors that lead to favoring 8Gy single fraction treatment. There was less consensus concerning single fraction treatment and favoring of other treatment approaches for lesions located on the spine, especially large lesions, and for patients with oligometastases and a longer prognosis where goals may include local tumor control in addition to palliation. Conclusions: Improving specification and communication of prognostic information is an important quality improvement target to enhance the patient-centered nature of care for patients with painful bone metastases.

Implementation of a rapid access multidisciplinary bone metastases clinic to improve access to care at a large cancer center.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 79-79 ◽  
Author(s):  
Lauren Elizabeth Colbert ◽  
Meaghan Gomez ◽  
Sarah Todd ◽  
Chad Tang ◽  
Kaitlin Christopherson ◽  
...  
Keyword(s):  
Bone Metastases ◽  
Orthopedic Surgery ◽  
Radiation Oncology ◽  
Multidisciplinary Care ◽  
Treatment Completion ◽  
Outpatient Setting ◽  
Cancer Center ◽  
Chi Square ◽  
Rapid Access ◽  
To Receive

79 Background: MD Anderson Cancer Center is a large cancer center with 44,000 new patients per year. Radiation therapy (RT) is an effective treatment for bone metastases that can reduce pain medication use and improve quality of life. Our goal was to assess the effect of implementing a rapid access multidisciplinary clinic for bone metastases (RABC). Methods: RABC was instituted to schedule patients for radiation oncology and orthopedic surgery consult within 48 hours of referral. Same day simulation and treatment times were held for these patients for one 8Gy fraction. Thirty sequential patients treated with one fraction to bony sites in the outpatient setting prior to implementation of the clinic were chosen as a comparison group. Time from consult order to consult visit (OTV) and from consult visit to treatment completion (CTT) were recorded, in addition to frequency of multidisciplinary care (MDC; orthopedic surgery and radiation oncology). Overall Time (OT) was calculated from referral to treatment completion. T-test and chi-square test were used for analyses. Results: Between April 2018 and July 2018, 72 patients were referred to RABC. 23 patients were seen in consultation and received RT. Sites treated were pelvis (N = 10), spine (N = 6), lower extremity (N = 4) and upper extremity (N = 3). Patients had one site (N = 20), two sites (N = 2) or three sites treated (N = 1). Histologies included breast (N = 5), thoracic (N = 7), gastrointestinal (N = 6), genitourinary (N = 2) and head/neck (N = 2). OTV was shorter for RABC patients (mean 3.3 [+/-5.7] vs. 9.5 days [12.4]; p = 0.02). CTT was also significantly shorter for RABC patients (mean 5.4 hours [+/-1.8] vs. 6.5 days [+/-6.5]; p < .0001). OT was also shorter (3.5 days [+/-5.6] vs. 16.4 days [+/-14.8]; p < .0001). RABC clinic patients were more likely to receive MDC (100% vs 28%; p < .0001). Conclusions: The rapid access bone metastases clinic significantly decreased overall time from consult to completion of treatment and also decreased time to access radiotherapy. Patients were also more likely to receive multidisciplinary evaluation. The RABC approach is a promising model to improve palliation for patients with painful bony metastases.

Sign in / Sign up

Export Citation Format

Share Document