30-Day Mortality in Palliative Radiotherapy

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Authors (including presenting author) :
Lee SF(1), Wong CS(1)
Affiliation :
(1)Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong
Introduction :
Palliative radiotherapy is widely used to relieve symptoms from either the primary tumour or sites of metastatic disease in advanced cancer, which often confers a poor prognosis. In patients with a limited prognosis, excessive fractionation can be considered an avoidable harm and poor use of healthcare resource.
Objectives :
30-day mortality (30DM) as a clinical indicator for the avoidance of harm, through appropriate patient selection, in palliative radiotherapy has not previously been demonstrated in Hong Kong. We aimed to assess 30DM following palliative RT at our centre.
Methodology :
A retrospective analysis of 30DM for all palliative radiotherapy delivered in Tuen Mun Hospital in 2017. Episodes were identified using the in-house radiotherapy electronic record with linkage to electronic patient records of the Hospital Authority. 30DM was assessed across all patient groups and by sites and fractionation pattern.
Result & Outcome :
1,065 palliative radiotherapy episodes were identified. Overall, 199 (18.7%) treatment were delivered to the spine, 151 (14.2%) to the chest, 97 (9.1%) to the brain, and 77 (7.2%) to the bones. Median treatment duration was 5 days (range 1–12). 84.3% received 5 fractions or less. Overall 30DM was 17.7% (188 patients), among which 61 (32.4%) treatment episodes were delivered to female. The most commonly treated diagnosis was lung cancer (39.4%). Factors having a significant impact upon 30DM were sex (male vs female odds ratio [OR] 1.56, 95% confidence interval [CI] 1.12, 2.18) and primary cancer diagnosis (Lip, oral cavity, and pharynx OR 0.31 [0.11, 0.87], genitourinary organs OR 0.57 [0.33, 0.98], and respiratory and intrathoracic organs 1.60 [1.17, 2.20]). This is the first large-scale study of 30-day mortality for unselected adult palliative radiotherapy treatments in Hong Kong. Most advanced cancer patients received hypofractionation radiotherapy. A balance needs to be achieved between duration of RT course and potential benefits through appropriate patient selection. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy, and further study in other centres and health care systems is required.

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