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• W2600963072 abstract "Palliative radiation therapy (PRT) is integral in symptom management for patients with advanced cancer. Limited data exist regarding differences in treatment pattern and outcome for advanced cancer patients in the hospitalized vs. ambulatory care setting. We characterized differences in care and survival of these patients receiving PRT. We identified ambulatory care and hospitalized patients with metastatic or incurable malignancies who underwent RT for palliation of bone mets at a tertiary care institution in New York City from 12/2010 to 2/2015. We extracted data on sociodemographics, comorbidities (summarized using Charlson comorbidity index [CCI]), cancer type, PRT details, pre- and 1 month post-PRT ECOG scores, and survival. Unadjusted comparisons of pre- vs. post-PRT ECOG scores and prescribed vs. actual fractions delivered were made using Wilcoxon signed-rank tests. Adjusted survival of patients treated in the hospitalized vs. ambulatory care setting was compared using Cox regression while controlling for age, gender, race/ethnicity, cancer, pre-PRT ECOG, and CCI. Of 212 patients in the study, 61% were male, median age was 61 (range 10-95) and median CCI was 9 (range 2-16). The most common primary cancers included myeloma (26%), liver/GI (19%), lung (15%), prostate/GU (14%), and breast (11%). Overall, 43% of patients underwent at least part of their PRT course during a hospitalization. Premature termination of PRT occurred in 10% of patients due to side effects (n=18), personal preference (n=3), or unknown reason (n=1). Hospitalized PRT patients had shorter survival than ambulatory care PRT patients (median 6 vs. 33 weeks, hazard ratio 4.02, [95% CI 2.39, 6.79], p<0.001). For hospitalized patients, median length of stay was 23 days (range 1-117), mean ECOG was 2.57 ± 0.87 pre-RT and 2.90 ± 1.11 post-RT (p<0.05) For ambulatory care patients, mean ECOG was 1.30 ± 0.73 pre-RT and 1.36 ± 0.96 post-RT (p=0.18). Median prescribed number of once-daily fractions for hospitalized patients was 9 (range 1-33); actual number given was 5 (range 1-15), p<0.01. For ambulatory care patients, prescribed number of once-daily fractions equaled the actual number given (median 10, range 1-30). Hospitalized patients undergoing PRT had worse functional status decline and survival than ambulatory care patients, yet both groups were prescribed similar PRT schedules. The actual number of fractions administered to hospitalized patients was significantly fewer than intended, probably due to declining functional status. The need to commence PRT in the hospital may be a poor prognostic sign and should prompt consideration of abbreviated PRT schedules for patients hospitalized with advanced cancer." @default.
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• W2600963072 date "2015-11-01" @default.
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• W2600963072 title "Differences in Treatment Pattern and Outcome of Hospitalized Versus Ambulatory Care Advanced Cancer Patients Receiving Palliative Radiation" @default.
• W2600963072 doi "https://doi.org/10.1016/j.ijrobp.2015.07.1755" @default.
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