30 day mortality in adult palliative radiotherapy – A retrospective population based study of 14,972 treatment episodes

Abstract

Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator.Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression.Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01).Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems.

Assessment of Predictive Scoring System for 90-Day Mortality Among Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma Who Have Completed Concurrent Chemoradiotherapy

“…9 Other studies on different cancer sites have reported 90-day mortality rates of 1.7% and 4.8% after radical RT. 10,11 However, only a few reports have documented the 90-day post-CCRT mortality rate specific to HNSCC, with a reported post-CCRT early mortality rate (ie, not specific to a 90-day threshold) of 5.4% to 18.3%. [12][13][14] In these studies, patient parameters that contributed to early mortality after RT included older age, male sex, low socioeconomic status, elevated white blood cell count, vascular comorbidities, poor performance status, low body mass index, and low peripheral blood total lymphocyte count.…”

“…These factors were associated with increased treatment-related mortality. [7][8][9][10][11][12][13][14] All prescribed radical treatments should achieve a 90-day mortality rate of less than 5% across all disease groups. 15 Thus, the primary aim of this study was to develop a suitable and accurate predictive scoring system for Taipei Medical University (TMU) to predict the 90-day mortality among patients with locally advanced HNSCC who are receiving CCRT.…”

Palliative radiotherapy (PRT) during the last month of life: A constant sorrow even in a dedicated PRT facility with research focus on this endpoint

“…Spencer et al have recently reported a population based study of 14,972 PRT episodes (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011), which were performed in a large cancer center in Leeds, UK [1]. Treatment was prescribed by approximately 20-30 different oncologists.…”

“…As discussed by Spencer et al [1], oncologists tend to overestimate survival of patients receiving palliative therapy. Given that short-course PRT regimens with no or minimal side effects exist, which nevertheless often improve symptoms, clinicians are afraid of withholding a meaningful therapeutic measure.…”

Prediction model for short-term mortality after palliative radiotherapy for patients having advanced cancer: a cohort study from routine electronic medical data

“…However, most of these studies are based on small study samples and hospital settings with short follow-up and survival times (in terms of weeks) or based on single tumor sites and are not specific to patients referred for RT [14][15][16][17] . Some studied the prognostic factors for survival time after palliative RT but did not develop a predictive model 3,18 . Palliative RT rarely affect survival time but often improves quality of life 19,20 .…”