Audit of 30-day mortality following palliative radiotherapy at Southend University Hospital

Denholm, Mary; Cooper, Sian; Malek, Abdul; Rubasingham, J.; Mithra, S.; Tsang, Derek S.

doi:10.1016/j.clon.2019.09.026

Cited by 3 publications

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“…The indication of PRT in patients with brain metastases, poor prognoses and short survival is questionable and they may be best treated with OSC mainly because their prevailing cause of 30-DM is the extracranial tumour progression [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

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Audit of 30-day mortality following palliative radiotherapy: Are we able to improve patient care at the end of life?

Vargas

2023

Rep Pract Oncol Radiother.

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Background Several measurements defining the expected 30-day mortality (30-DM) to use in audit of radiation oncology departments have been proposed. However, its external validity is limited because of the lack of data from non-English speaking countries. This study assessed 30-DM in patients treated with palliative radiotherapy (PRT) in a Chilean-reference radiotherapy centre and explored if there had been tailored treatment at the end of life. Materials and methods Retrospective data collection was carried out for all patients treated at our institution between 1 st January 2018 and 31 st December 2021. Individual factors were modelled first to check for univariate association with 30-DM, those variables with a significance level of < 0.05 were considered for the final multivariable model. Results 3,357 patients were included. The most common primary malignancies were breast (22%) and lung (16.1%). The most common treatment sites were bone (47.7%) and brain (12.2%). Overall, 30-DM was 14.7%, this rate was higher in patients treated for brain metastases (25.7%) and thoracic palliation (22.1%). 30-DM was associated with poor performance status (p < 0.01), lung and esophageal-gastric cancer (p = 0.04 and p = 0.02, respectively), metastases other than bone (p < 0.01), brain metastases (p < 0.01) and private health insurance (p <0.01). Conclusions In patients treated for brain metastasis and thoracic palliation 30-DM was higher than suggested benchmarks. Moreover, in these groups long courses of PRT were often performed. Audit data should be useful for planning interventions that improve selection of patients and prompting review of policies for indication and fractionation schedules of PRT.

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Section: Discussionmentioning

confidence: 99%

“…However, as in other studies, audit 30-DM may be useful for planning interventions that improve selection of patients and prompting review of policies for indication and fractionation schedules of PRT, especially when resources are limited [ 22 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Audit of 30-day mortality following palliative radiotherapy: Are we able to improve patient care at the end of life?

Vargas

2023

Rep Pract Oncol Radiother.

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“…While there remains some debate [8▪], agreement exists that RT courses during this period should be minimized, and when performed should be brief: 1–5 fractions wherever possible. The UK Royal College of Radiologists has stated that fewer than 20% of patients receiving palliative RT will die within 30 days of treatment [9]. The actual value varies markedly between centers, but has been shown to be between 5% and 24% [7,10▪,11,12].…”

Section: Introductionmentioning

confidence: 99%

Thirty-day mortality as a metric for palliative radiotherapy in pediatric patients

Keit,

Nanda,

Johnstone

2024

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Thirty-day mortality (30DM) is an emerging consideration for determining whether terminally ill adult patients may benefit from palliative radiotherapy (RT). However, the efficacy and ethics of delivering palliative RT at the end of life (EOL) in children are seldom discussed and not well-established. Recent findings Palliative RT is perhaps underutilized among patients ≤21 years old with rates as low as 11%. While effective when delivered early, clinical benefit decreases when administered within the last 30 days of life. Pediatric 30DM rates vary widely between institutions (0.7–30%), highlighting the need for standardized practices. Accurate prognosis estimation remains challenging and prognostic models specific to palliative pediatric patients are limited. Discordance between provider and patient/parent perceptions of prognosis further complicates decision-making. Summary RT offers effective symptom control in pediatric patients when administered early. However, delivering RT within the last 30 days of life may provide limited clinical benefit and hinder optimal EOL planning and care. Early referral for palliative RT, preferably with fewer fractions (five or fewer), along with multidisciplinary supportive care, optimizes the likelihood of maintaining patients’ quality of life. Prognosis estimation remains difficult, and improving patient and family understanding is crucial. Further research is needed to refine prognostic models and enhance patient-centered care.

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Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: A meta-analysis

Kutzko

Dadwal

Holt

et al. 2022

Radiotherapy and Oncology

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Audit of 30-day mortality following palliative radiotherapy at Southend University Hospital

Cited by 3 publications

References 0 publications

Audit of 30-day mortality following palliative radiotherapy: Are we able to improve patient care at the end of life?

Audit of 30-day mortality following palliative radiotherapy: Are we able to improve patient care at the end of life?

Thirty-day mortality as a metric for palliative radiotherapy in pediatric patients

Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: A meta-analysis

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