Influence of palliative care consult on radiation therapy utilization for metastatic cancer patients within the last six months.

Abstract

149 Background: Palliative care encounters (PCE) have been demonstrated to reduce resource utilization and costs within an inpatient setting. Little is known about influence PCE on delivery of radiation therapy (RT). We hypothesize that terminally ill cancer patients completing PCE would have increased utilization of palliative RT (PRT) with decreased fractions and overall costs. Methods: Retrospective review of 3,128 cancer patients that had at least one hospital contact within 6 months prior to death. Data from single academic institution decedent database, hospital billing claims, and radiation oncology electronic medical record (RO EMR) was combined into one database that could be queried. Results: From January 2009 to June 2011, 417 patients with soft tissue/bone/not other specified (NOS) excluding brain metastatic disease and at least one palliative contact within 6 months prior to death were identified. Palliative contact: PRT or palliative care consult or admission (PCE). 232 patients completed 321 RT courses (87% palliative, 8% curative, and 5% unknown). 18% of PRT was delivered in 1 fraction, 30% in 2-5, 4% in 6-9, 36% in 10, and 12% > 10 fractions. PRT and PCE were both completed in 48% (33% before, 13% during and 54% after delivery of RT). PCE prior to PRT vs. PCE none/during/after PRT were more likely to result in 5 or fewer PRT treatments (62% vs. 40%, p=0.0309) and there was a trend for increased delivery of single fraction PRT (18 vs. 15%). Based on timing of PCE, no increase in PRT courses per patient and no overall cost reduction was observed beyond direct cost reduction by reducing PRT fractions. Other non-significant factors included sex, race, and payer type. Majority of PCE were within 30 days prior to death 52% vs. only 44% of PRT. Conclusions: Relationship between PCE and PRT is complex and are likely compounded by factors not accounted for in this study. Despite these limitations, PCE prior to delivery of PRT correlates to reduced treatment numbers. This report highlights that overall referrals for palliative services could be integrated into comprehensive cancer much earlier and in a more multi-disciplinary way.

Palliative radiotherapy: history, recent advances, and future directions

“…The development of dedicated palliative radiation oncology clinical services within academic radiation oncology departments has greatly enhanced the standing of the subspecialty in the oncology community (5,6). These dedicated services permit focused training of palliative care principles that may not otherwise be presented in the average residency training setting (7). The uniformity of care made possible by the existence of a dedicated palliative radiation oncology service permits more robust brainstorming, conceptualization, and implementation of palliative radiotherapy research initiatives.…”