Cost-Effectiveness and Toxicity of Radiation Therapy Technique in the Palliative Treatment of Spine Metastases

Poster Viewing Session E479

Volume 93  Number 3S  Supplement 2015 with palliative medicine. Author Disclosure: S.N. Elmore: Research Grant; ASCO/Conquer Cancer Foundation. T.A. Balboni: None.

3196 Cost-Effectiveness and Toxicity of Radiation Therapy Technique in the Palliative Treatment of Spine Metastases V. Kudithipudi,1 P. Gabani,2 and R. Fuhrer3; 1Allegheny Health Network, Pittsburgh, PA, 2Temple University School of Medicine, Philadelphia, PA, 3 Allegheny Health Network, Pittsburgh, PA Purpose/Objective(s): To analyze rates of inpatient admission, sequelae of admission, and cost effectiveness of AP/PA versus 3D-Conformal (3DCRT) radiation therapy in the palliative management of spine metastases. Materials/Methods: Patients with pathologic or radiographically proven malignancy treated with palliative intent for cervical, thoracic, or lumbosacral spine metastasis treated at a single institution from 20092013 were retrospectively reviewed. 151 patients were included in the analysis and all had signed an IRB approved consent to participate in this study. 53 patients were treated AP/PA, and 98 were treated with 3 or more fields (to minimize dose to critical structures). All patients underwent 3D computed tomography simulation (3-mm-thick slices) with a Siemens Somatom Sensation Open scanner (Siemens Medical). All patients were positioned in supine position with vacuum bag immobilization. A clinical target volume (CTV) was determined and treatments were planned with XiO treatment planning system (Elekta). Patients were treated via megavoltage linear accelerator (Siemens Medical) with image guidance via cone beam CT or weekly port films. Inpatient electronic medical record was analyzed for post radiation therapy hospital admission data and sequelae of admission. Medicare billing costs for radiation therapy and average costs of daily inpatient admission were reviewed. Results: Mean ECOG performance status prior to treatment was 1.7 and was not significantly different between groups. Within 60 days of completion of radiation therapy, 47% (25) of AP/PA and 32% (31) of the 3DCRT patients experienced an inpatient admission (pZ.045; Barnard’s exact test). The absolute risk reduction and relative risk reduction of inpatient admission for 3DCRT patients versus AP/PA patients were 15.53% and 32.94%, respectively. Average length of admission was 6.92 days for AP/PA and 6.19 days for 3DCRT (NS). Number needed to treat with 3DCRT to prevent one inpatient admission was 7. Sequelae of admission, including sepsis, venous thromboembolic event, hospital-acquired pneumonia, and death in this single institution were rare and not statistically different between groups. The difference in Medicare billing cost of the average 10 fraction AP/PA treatment versus 3D conformal treatment was $1,621. The average hospital adjusted expense per inpatient day for nonprofit centers in the US in 2012 was $2,214, for an average 7 day admission costing $15,498. Conclusion: 3DCRT is associated with a lower rate of inpatient admission than AP/PA palliative treatment of spine metastases. Cost difference between treatment modalities is minimal and is likely to be offset by decreased incidence of inpatient admission due to lower patient morbidity. Author Disclosure: V. Kudithipudi: None. P. Gabani: None. R. Fuhrer: None.

3197 Clinical Features and Outcomes of Pediatric Patients Undergoing Palliative Radiation Therapy S. Varma,1 M.J. Stavas,1 and A.N. Kirschner2; 1Vanderbilt University, Nashville, TN, 2Vanderbilt University Medical Center, Nashville, TN Purpose/Objective(s): There are few published data on the use and outcomes of palliative RT in the pediatric population. In this study, we aimed to characterize the clinical presentation and outcomes of children receiving palliative RT at an academic medical center.

Materials/Methods: A retrospective chart review was performed on all patients receiving palliative RT under age 18 seen in our clinic over a 10 year period, from January 2005-January 2015. Results: In the specified time period, 49 pediatric oncology patients underwent radiation therapy with palliative intent. Of these, 4 patients underwent 2 courses and 9 had 3 or more courses, with a total of 82 palliative courses administered. Follow-up data were available until time of death in 42 patients and for a median 270 d (range 25-558 d) in the 7 patients alive at last follow-up. The most common histologies were neuroblastoma (23.2%), rhabdomyosarcoma (18.3%), Ewing’s sarcoma (9.8%), and hematologic malignancies (9.8%). Sites treated included extremities (28.0%), spine (20.7%), abdomen and/or pelvis (19.5%), head & neck (14.6%), as well as brain, thorax, and liver (each <10%). Indications for palliative RT included pain (58.5%), neurologic deficits (19.5%), dyspnea (9.8%), other symptoms (29.3%), and the prevention of impending symptoms (13.4%). Of patients with pain, 77.1% received partial or complete symptom relief, 62.5% for neurologic deficits, and 62.5% for dyspnea. Of patients treated preventatively, 81.8% remained asymptomatic at the treated site until time of death or last follow-up. Median RT dose delivered was 20.5 Gy (range 1.5-55.2 Gy). There were 8 RT courses (9.8%) stopped early due to clinical decline or family preference. Treatment to doses >30 Gy did not show a statistically significant improvement in response rate (one-way ANOVA, F (1.65) Z 3.16, p Z 0.08). Of symptomatic sites that responded to the first palliative treatment, 25% subsequently had return of symptoms and 3 patients required repeat palliative RT after medical management of recurrent symptoms failed. Median survival after palliative RT was 125 d (range 11141 d). Of the 49 palliative patients, 7 (14.3%) received RT in their last 7 days of life. Conclusion: Palliative RT can be used to relieve and prevent a range of symptoms including pain, neurologic deficits, and dyspnea in a wide variety of pediatric cancer histologies. Treatment to doses >30 Gy may not significantly improve palliative response in these children. Author Disclosure: S. Varma: None. M.J. Stavas: None. A.N. Kirschner: None.

3198 Documentation of Palliative Radiation Therapy Response in the Last Six Months of Life: Are We Capturing the Data? S. Zuckoff, J.M. Schuster, H. Lomas, IV, M.S. Anscher, and A.I. Urdaneta; Virginia Commonwealth University Medical Center, Richmond, VA Purpose/Objective(s): The integration of palliative care and standard oncologic care improves quality of life, symptoms, and survival outcomes in cancer patients. Radiation oncologists (RO) provide palliative services to many of these patients near the end of life. We sought to determine how RO document the management of symptoms for oncology patients receiving palliative radiation therapy (RT) for metastatic disease at the end of life. Materials/Methods: RO electronic medical records were retrospectively reviewed for 3,128 cancer patients from a single academic institution that had at least one hospital contact within their last 6 months of life. From this decedent database, patients with metastatic disease who received palliative RT were identified. All RO clinical notes within patients’ last 6 months of life were reviewed for documentation of symptoms, management, response to treatment, and subsequent disposition, including referrals to hospice and palliative care. Results: There were 572 clinical encounters among 203 patients (20082011), ranging in age from 19-88 years old. Clinical notes included follow-up (FU) (nZ111), end of treatment (EOT) (nZ231), reevaluation (nZ83), and consult notes (nZ138). The most common documented symptom was pain (nZ262), followed by neurologic symptoms (nZ23). Pain score was documented 34% of the time with an average score of 6.8 (range 0-10). Patients reported an average of 1.4 pain sites per encounter with the most common sites being back (nZ58) and hips (nZ47). This was addressed in the treatment plan 86% of the time. The documented