Caution is required in the implementation of 90-day mortality indicators for radiotherapy in a curative setting: A retrospective population-based analysis of over 16,000 episodes

Abstract

Background90-day mortality (90 DM) has been proposed as a clinical indicator in radiotherapy delivered in a curative setting. No large scale assessment has been made. Its value in allowing robust comparisons between centres and facilitating service improvement is unknown.MethodsAll radiotherapy treatments delivered in a curative setting over seven years were extracted from the local electronic health record and linked to cancer registry data. 90 DM rates were assessed and factors associated with this outcome were investigated using logistic regression. Cause of death was identified retrospectively further characterising the cause of 90 DM.ResultsOverall 90 DM was 1.25%. Levels varied widely with diagnosis (0.20–5.45%). Age (OR 1.066, 1.043–1.073), year of treatment (OR 0.900, 0.841–0.969) and diagnosis were significantly associated with 90 DM on multi-variable logistic regression. Cause of death varied with diagnosis; 50.0% post-operative in rectal cancer, 40.4% treatment-related in head and neck cancer, 59.4% disease progression in lung cancer.ConclusionDespite the drive to report centre level comparative outcomes, this study demonstrates that 90 DM cannot be adopted routinely as a clinical indicator due to significant population heterogeneity and low event rates. Further national investigation is needed to develop a meaningful robust indicator to deliver appropriate comparisons and drive improvements in care.

Early (90‐day) mortality after radical radiotherapy for head and neck squamous cell carcinoma: A population‐based analysis

“…Spencer et al also recently reported on 90‐day mortality after curative RT in Leeds, United Kingdom, for all tumor sites . Interestingly, their 90‐day mortality rate for the 1156 patients with head and neck cancer who were included was 3.7%, with 83% of deaths attributed to treatment or the underlying cancer, nearly identical to the results in our study …”

Determining Malnutrition Assessment Criteria to Predict One-Year Mortality for Locally Advanced Head and Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy

“…The enrolled patients were stage III, IVA, or IVB patients who received standard concurrent chemoradiation (CCRT) at a single institution to minimize bias effects from a heterogeneous population and different treatment protocols. The reported 60 and 90-day short-term mortality for LAHNC patients after completion of CCRT ranged from 4.7% to 7.2% [8][9][10][11], but the one year mortality can escalate up to 25% [12][13][14]. Understanding the relevant nutritional assessment parameters for prediction of one year mortality in LAHNC patients will allow clinicians to identify malnutrition early and offer prompt action that may reduce mortality.…”

Mortality during or shortly after curative-intent radio-(chemo-) therapy over the last decade at a large comprehensive cancer center

“…This cut-off was chosen, as it was reported in the two quoted ASTRO abstracts [3] , [4] , and also because it is commonly used in the palliative RT literature when assessing therapy close to end-of-life [6] , [7] . While it is an open question of whether 30-, 90- or even 180-day mortality after RCT should be regarded as quality measure, the contrast between a high potential for cure after a weeks-long therapy regimen versus death during or shortly after therapy seems most pronounced [2] , [8] . Curative therapy was defined as curative-intent per the treating radiation oncologist, with a prescribed dosage of an equivalent in 2 Gy single dose (EQD2) ≥ 50 Gy for RTs alone, EQD2 ≥ 40 Gy for RCTs and even lower dose cut-offs for lymphoma patients.…”

“…Mortality during or shortly after treatment, often termed peri-radiotherapeutic (peri-RT) mortality , in patients undergoing curative-intent radiotherapy (RT) or radiochemotherapy (RCT) have not been studied systematically. Only a few site-specific and one more broadly conceptualized report are published in the pertinent literature to date [1] , [2] .…”