- Email: [email protected]
Comparing Rapid Palliative IG-IMRT with More Conventional Simulation and Treatment Approaches
I. J. Radiation Oncology d Biology d Physics
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Volume 72, Number 1, Supplement, 2008
compare these parameters as potential predictors of observer or patient reported cumulative dysphagia during the chronic phase (OCh-AUC and P-Ch-AUC respectively) as well as objective swallowing impairment represented by VF summary score. Results: There was a strong correlation between O-Ac-Max and O-Ac-AUC (R=0.69, p \ 0.0001). O-Ac-AUC and O-Ac-Max were each predictive for VF score 3 m after RT with R=0.53 (p = 0.0003) and 0.66 (p \ 0.0001) respectively, and for O-Ch-AUC with R=0.59 (p \ 0.0001) and 0.44 (p = 0.002) respectively. O-Ch-AUC strongly correlated with P-Ch-AUC as assessed by three different dysphagia specific questions (R range of 0.67-0.72, p \ 0.0001). O-Ac-AUC predicted for VF score 12 m after RT (R=0.43, p = 0.02) and P-Ch-AUC (R range 0.32-0.34, p # 0.033) while O-Ac-Max was not predictive for these parameters. Conclusions: CTCAE based observer rated maximal dysphagia and AUC of dysphagia during RT were found to be highly correlated. Each was found to be predictive of objective swallowing impairment 3 m after RT and of O-Ch-AUC. The O-Ac-AUC may be more predictive than the maximal score for patient-reported dysphagia during the chronic phase and for objective swallowing impairment at 12 m. This study is the first to validate the role of the CTCAE based observer rated dysphagia as a valuable tool. Author Disclosure: I. Gluck, None; K. Agbulos, None; D.B. Chepeha, None; T. Lyden, None; M. Haxer, None; A. Popovtzer, None; O. Gutfeld, None; A. Eisbruch, None.
1060
A Phase I/II Dose-Escalation/Efficacy Study of Single Fraction Stereotactic Body Radiotherapy (SF-SBRT) for Metastatic Cancer
J. J. Urbanic1, K. P. McMullen1, V. W. Stieber2, W. H. Hinson1, W. T. Kearns1, C. J. Hampton1, J. F. Lovato1, K. Livengood1, R. Rosdahl1, A. W. Blackstock1 1 Wake Forest University School of Medicine, Winston-Salem, NC, 2Derrick L. Davis Forsyth Regional Cancer Center, Winston-Salem, NC
Purpose/Objective(s): At the time of study design, no clear dosing guidelines had been established for stereotactic body radiotherapy (SBRT) for palliation and treatment of metastatic cancer. A Phase I/II study was undertaken to establish the maximum tolerated dose (MTD) of single fraction stereotactic body radiotherapy (SF-SBRT) and determine the local control (LC) of the lesions treated. Materials/Methods: Eligibility included age $18 years, physician assessed life expectancy $3 months, and no systemic therapy 3 weeks prior or planned 4 weeks after radiosurgery. Maximum tumor diameter 6 cm, one lesion treated on protocol per patient. Continuous reassessment method was used to accrue Phase I and II arms in alternating succession. Stratification for dose escalation into 3 groups by gross tumor volume (GTV): \25 cm3, 25-65 cm3, .65-120 cm3. GTV equaled gross disease visible on CT imaging. Planning target volume (PTV) was a uniform 7 mm expansion. Radiation treatment planning (Phillips, Pinnacle3) for SBRT in commercially available bodyframe (Elekta). Any beam arrangement or block margin was allowed provided $95% of GTV encompassed within 65% (±15%) isodose curve to which Rx dose was re-normalized. Toxicity graded per NCI CTC v2.0. LC determined using RECIST criteria. Overall survival (OS) and LC determined using Kaplan-Meier methods, group comparisons made using log-rank analysis. Results: Between July 2002 and April 2007, 48 patients (pts) with metastatic tumors enrolled. Median age was 63.5 years (39-83). 22 pts were entered on Phase I portion. MTD was not reached at max dose to GTV of 32.4 Gy (small), 28.5 Gy (medium), 20 Gy (large). Of the 48 Phase I/II pts, 3 pts experienced a grade 3 pulmonary toxicity and 46 pts were evaluable for response, survival, and toxicity (2 pts treated conventionally after enrollment); median follow-up is 16.7 months (1.1-53); the median OS is 18.2 months (95% CI 15.8-31.8). No significant OS differences based on dose, histology, or disease site. 3 additional pts not evaluable for response (1 pt died 1 month post SF-SBRT with progressive CNS disease, 1 pt no pathologic diagnosis, 1 pt had prior infield radiotherapy), thus for 43 evaluable pts the median progression-free survival was 8.3 months (95% CI 6.7-12.4). Based on RECIST, best overall response: complete 3, partial 10, stable 29, progression 1. For thoracic lesions vs. other sites, median time to local progression 11.6 months vs. 5.7 months (p = 0.05). No apparent dose response seen for local control. Conclusions: Using SF-SBRT techniques, the MTD dose was not reached for small, medium, or large lesions. Overall toxicity was minimal. While LC was achieved in most pts using a large single fraction, as expected, most patients died of progressive systemic disease. Author Disclosure: J.J. Urbanic, None; K.P. McMullen, None; V.W. Stieber, None; W.H. Hinson, None; W.T. Kearns, None; C.J. Hampton, None; J.F. Lovato, None; K. Livengood, None; R. Rosdahl, None; A.W. Blackstock, None.
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Comparing Rapid Palliative IG-IMRT with More Conventional Simulation and Treatment Approaches 1,2
R. Samant , L. Gerig1,2, L. Montgomery1, M. MacPherson3,4, G. Fox1, R. MacRae1,2, K. Carty1, S. Andrusyk1, P. Genest1,2, B. Nyiri1,2 1 The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, 2University of Ottawa, Ottawa, ON, Canada, 3Carlo Fidani Peel Regional Cancer Centre, Mississauga, ON, Canada, 4University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): To evaluate the feasibility of using an integrated imaging, planning, and treatment delivery system to deliver IG-IMRT for patients requiring urgent palliative radiotherapy (PRT). Materials/Methods: Between December 2006 and February 2008, 23 patients requiring urgent PRT were selected to undergo single-session MV-CT simulation, IMRT treatment planning, and delivery of the first fraction of radiotherapy on a helical Tomotherapy unit. The time required to complete each step was recorded along with the overall time spent in the treatment room. This was compared to the time required for our standard approach for PRT with either fluoroscopic or CT-based simulation, simple treatment planning, and treatment on a megavoltage machine (Cobalt-60 unit or 6 MV linac). The IMRT distributions were compared with the more conventional treatments plans that would normally be used. Results: Twenty-three patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were as follows: 66% for painful bone metastases, 17% for bleeding, and 17% for other reasons. The average time required for the various processes was as follows: 15 minutes for MV-CT acquisition, 16 minutes for
Proceedings of the 50th Annual ASTRO Meeting target volume delineation, 9 minutes for IMRT planning, 10 minutes for the repeat verification MV-CT, and 12 minutes for delivery of the first radiotherapy fraction. The average total time spent in the treatment room by patients was 62 minutes, and this decreased during the course of the study from over 90 minutes initially to approximately 60 minutes. The average time for our standard approach for simulation and immediate treatment for patients requiring urgent PRT with either fluoroscopy or conventional CT-simulation was 59 minutes and 92 minutes, respectively, and this excludes the time required to transfer patients between rooms and the waiting time between simulation and treatment. The IMRT dose distributions were more conformal than with the conventional approaches; with a more homogeneous dose to the target volume and a marked reduction in hotspots. This protocol was used for patients requiring single-fraction (8 patients) and short-course (15 patients receiving 2-5 fractions) PRT. The delivery quality assurance (DQA) done following the first fraction of treatment demonstrated good agreement between planned and delivered dose. Conclusions: Palliative radiotherapy with IG-IMRT using an integrated imaging-planning-treatment delivery system is efficient and convenient for patients, and compares very favorably with conventional approaches. This is one of the first such reported series of rapid one-session IG-IMRT and it has great potential for future applications, including single-fraction radiotherapy. Author Disclosure: R. Samant, None; L. Gerig, Honoraria, D. Speakers Bureau/Honoraria; L. Montgomery, Honoraria, D. Speakers Bureau/Honoraria; M. MacPherson, Honoraria, D. Speakers Bureau/Honoraria; G. Fox, None; R. MacRae, None; K. Carty, None; S. Andrusyk, None; P. Genest, None; B. Nyiri, None.
1062
Functional Interference Clusters in Cancer Patients with Bone Metastases: An Analysis of RTOG 9714
1
E. Chow , J. James2, A. Barsevick3, W. Hartsell4, C. Scarantino5, R. Ivker6, M. Roach7, J. Suh8, I. Petersen9, D. Bruner10 1 Odette Cancer Center, Toronto, ON, Canada, 2RTOG, Philadelphia, PA, 3Fox Chase Cancer Center, Cheltenham, PA, 4Good Samaritan Cancer Center, Downers Grove, IL, 5Rex Healthcare Cancer Center, Raleigh, NC, 6Newark Beth Israel Medical Center, Newark, NJ, 7UCSF Comprehensive Cancer Center, San Francisco, CA, 8Cleveland Clinic Foundation, Cleveland, OH, 9 Mayo Clinic, Rochester, MN, 10Abramson Cancer Center, Philadelphia, PA
Purpose/Objective(s): The primary objective was to explore if functional interference items in Brief Pain Inventory (BPI) clustered in cancer patients with bone metastases. Secondary objective was to determine whether such clusters (if any) changed with palliative radiotherapy (RT) between responders and non-responders. Materials/Methods: Worst pain at the treatment site and functional interference scores were assessed using BPI at baseline, 4, 8, and 12 weeks post-randomization. A principal component analysis was performed on the 7 functional interference items at all time points to determine their interrelationships. Principal components with an Eigenvalue greater than 1 or which explained more than 10% of the variance was retained. The Cronbach a statistic was used to estimate the internal consistency and reliability of the derived clusters. Results: All eligible patients enrolled in RTOG 9714 (randomized between a single 8 Gy and 30 Gy in 10 fractions) were included in the analysis. The median age was 67 years and gender distributions were approximately equal. Of the 909 patients, 445 (49%) responded to treatment within 12 weeks. Two clusters were identified at baseline. The first cluster included general activity, normal work, and walking ability and accounted for 58% of the total variance. The second cluster included enjoyment of life, mood, relations with others, and sleep and accounted for 13% of the total variance with Cronbach a statistic 0.83 and 0.80 respectively. Radiotherapy significantly improved general activity, mood, normal work, relations with others, and sleep item scores over time when adjusting for responder status. In responders, the two clusters did not persist beyond baseline. In non-responders, the general activity, normal work, and walking ability cluster remained consistent, the mood and enjoyment of life items interchanged at week 8, but the two clusters disappeared only at week 12. Conclusions: Palliative radiotherapy has been proven effective in alleviating symptomatic bone pain and reducing functional interference over time. Functional interference clusters exist in cancer patients with bone metastases. Treating pain with radiotherapy would disintegrate such clusters. Author Disclosure: E. Chow, None; J. James, None; A. Barsevick, None; W. Hartsell, None; C. Scarantino, None; R. Ivker, None; M. Roach, None; J. Suh, None; I. Petersen, None; D. Bruner, None.
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Multidisciplinary Team Contributions within a Rapid Access Palliative Radiotherapy Program
E. Pituskin1,2, A. Fairchild1,2, J. Dutka1, P. Tachynski1, A. Driga1, J. Borschneck1 1
Cross Cancer Institute, Edmonton, AB, Canada, 2University of Alberta, Edmonton, AB, Canada
Purpose/Objective(s): The majority of patients with bone metastases (BM) secondary to cancer experience symptoms such as pain or impaired mobility, and may require multiple medications for analgesia, with attendant side effects. Palliative-intent radiotherapy (RT) is effective in decreasing pain, but in the usual model of RT delivery, additional supportive care interventions can be overlooked. While ‘multi-disciplinary’ is a catchword often used to describe clinics in various settings, recommendations from allied health practitioners are rarely included in patients’ overall treatment plan. However, provision of such supportive care is one of the goals of the Rapid Access Palliative Radiotherapy Program (RAPRP), along with timely patient assessment and delivery of RT for BM. The purpose of this project was to determine the feasibility of multidisciplinary assessment in the setting of a rapid access outpatient RT clinic. Materials/Methods: RAPRP disciplines (Pharmacy [RX], Occupational Therapy [OT], Clinical Nutrition [CN], Social Work [SW]) developed screening forms to streamline assessment, performed consultations within the clinic, and arranged follow-up as necessary. Recommendations were included within the final treatment plan and tracked for patients attending clinic. RX and OT participated for the entire pilot (Jan-June 2007), while CN and SW joined the RAPRP team in March. Results: 58 patients with painful BM were assessed over a 25 week pilot period. Median age was 69.9 years (range, 39-86), 64% had prostate cancer, median performance status was 70. Pain was rated on average 6.1/10 at baseline and average oral morphine equivalent daily dose (MEDD) was 83 mg/24 hrs (range, 0-2000 mg). 40/58 (69%) patients were seen by RX, who completed a medical history in 90%. Based on the results of the screening tools, 19/58 (33%) patients were seen by OT, 9/58 (16%) were
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compare these parameters as potential predictors of observer or patient reported cumulative dysphagia during the chronic phase (OCh-AUC and P-Ch-AUC respectively) as well as objective swallowing impairment represented by VF summary score. Results: There was a strong correlation between O-Ac-Max and O-Ac-AUC (R=0.69, p \ 0.0001). O-Ac-AUC and O-Ac-Max were each predictive for VF score 3 m after RT with R=0.53 (p = 0.0003) and 0.66 (p \ 0.0001) respectively, and for O-Ch-AUC with R=0.59 (p \ 0.0001) and 0.44 (p = 0.002) respectively. O-Ch-AUC strongly correlated with P-Ch-AUC as assessed by three different dysphagia specific questions (R range of 0.67-0.72, p \ 0.0001). O-Ac-AUC predicted for VF score 12 m after RT (R=0.43, p = 0.02) and P-Ch-AUC (R range 0.32-0.34, p # 0.033) while O-Ac-Max was not predictive for these parameters. Conclusions: CTCAE based observer rated maximal dysphagia and AUC of dysphagia during RT were found to be highly correlated. Each was found to be predictive of objective swallowing impairment 3 m after RT and of O-Ch-AUC. The O-Ac-AUC may be more predictive than the maximal score for patient-reported dysphagia during the chronic phase and for objective swallowing impairment at 12 m. This study is the first to validate the role of the CTCAE based observer rated dysphagia as a valuable tool. Author Disclosure: I. Gluck, None; K. Agbulos, None; D.B. Chepeha, None; T. Lyden, None; M. Haxer, None; A. Popovtzer, None; O. Gutfeld, None; A. Eisbruch, None.
1060
A Phase I/II Dose-Escalation/Efficacy Study of Single Fraction Stereotactic Body Radiotherapy (SF-SBRT) for Metastatic Cancer
J. J. Urbanic1, K. P. McMullen1, V. W. Stieber2, W. H. Hinson1, W. T. Kearns1, C. J. Hampton1, J. F. Lovato1, K. Livengood1, R. Rosdahl1, A. W. Blackstock1 1 Wake Forest University School of Medicine, Winston-Salem, NC, 2Derrick L. Davis Forsyth Regional Cancer Center, Winston-Salem, NC
Purpose/Objective(s): At the time of study design, no clear dosing guidelines had been established for stereotactic body radiotherapy (SBRT) for palliation and treatment of metastatic cancer. A Phase I/II study was undertaken to establish the maximum tolerated dose (MTD) of single fraction stereotactic body radiotherapy (SF-SBRT) and determine the local control (LC) of the lesions treated. Materials/Methods: Eligibility included age $18 years, physician assessed life expectancy $3 months, and no systemic therapy 3 weeks prior or planned 4 weeks after radiosurgery. Maximum tumor diameter 6 cm, one lesion treated on protocol per patient. Continuous reassessment method was used to accrue Phase I and II arms in alternating succession. Stratification for dose escalation into 3 groups by gross tumor volume (GTV): \25 cm3, 25-65 cm3, .65-120 cm3. GTV equaled gross disease visible on CT imaging. Planning target volume (PTV) was a uniform 7 mm expansion. Radiation treatment planning (Phillips, Pinnacle3) for SBRT in commercially available bodyframe (Elekta). Any beam arrangement or block margin was allowed provided $95% of GTV encompassed within 65% (±15%) isodose curve to which Rx dose was re-normalized. Toxicity graded per NCI CTC v2.0. LC determined using RECIST criteria. Overall survival (OS) and LC determined using Kaplan-Meier methods, group comparisons made using log-rank analysis. Results: Between July 2002 and April 2007, 48 patients (pts) with metastatic tumors enrolled. Median age was 63.5 years (39-83). 22 pts were entered on Phase I portion. MTD was not reached at max dose to GTV of 32.4 Gy (small), 28.5 Gy (medium), 20 Gy (large). Of the 48 Phase I/II pts, 3 pts experienced a grade 3 pulmonary toxicity and 46 pts were evaluable for response, survival, and toxicity (2 pts treated conventionally after enrollment); median follow-up is 16.7 months (1.1-53); the median OS is 18.2 months (95% CI 15.8-31.8). No significant OS differences based on dose, histology, or disease site. 3 additional pts not evaluable for response (1 pt died 1 month post SF-SBRT with progressive CNS disease, 1 pt no pathologic diagnosis, 1 pt had prior infield radiotherapy), thus for 43 evaluable pts the median progression-free survival was 8.3 months (95% CI 6.7-12.4). Based on RECIST, best overall response: complete 3, partial 10, stable 29, progression 1. For thoracic lesions vs. other sites, median time to local progression 11.6 months vs. 5.7 months (p = 0.05). No apparent dose response seen for local control. Conclusions: Using SF-SBRT techniques, the MTD dose was not reached for small, medium, or large lesions. Overall toxicity was minimal. While LC was achieved in most pts using a large single fraction, as expected, most patients died of progressive systemic disease. Author Disclosure: J.J. Urbanic, None; K.P. McMullen, None; V.W. Stieber, None; W.H. Hinson, None; W.T. Kearns, None; C.J. Hampton, None; J.F. Lovato, None; K. Livengood, None; R. Rosdahl, None; A.W. Blackstock, None.
1061
Comparing Rapid Palliative IG-IMRT with More Conventional Simulation and Treatment Approaches 1,2
R. Samant , L. Gerig1,2, L. Montgomery1, M. MacPherson3,4, G. Fox1, R. MacRae1,2, K. Carty1, S. Andrusyk1, P. Genest1,2, B. Nyiri1,2 1 The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada, 2University of Ottawa, Ottawa, ON, Canada, 3Carlo Fidani Peel Regional Cancer Centre, Mississauga, ON, Canada, 4University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): To evaluate the feasibility of using an integrated imaging, planning, and treatment delivery system to deliver IG-IMRT for patients requiring urgent palliative radiotherapy (PRT). Materials/Methods: Between December 2006 and February 2008, 23 patients requiring urgent PRT were selected to undergo single-session MV-CT simulation, IMRT treatment planning, and delivery of the first fraction of radiotherapy on a helical Tomotherapy unit. The time required to complete each step was recorded along with the overall time spent in the treatment room. This was compared to the time required for our standard approach for PRT with either fluoroscopic or CT-based simulation, simple treatment planning, and treatment on a megavoltage machine (Cobalt-60 unit or 6 MV linac). The IMRT distributions were compared with the more conventional treatments plans that would normally be used. Results: Twenty-three patients were treated with our integrated IG-IMRT protocol. The median age was 72 years, with 61% men and 39% women. The indications for PRT were as follows: 66% for painful bone metastases, 17% for bleeding, and 17% for other reasons. The average time required for the various processes was as follows: 15 minutes for MV-CT acquisition, 16 minutes for
Proceedings of the 50th Annual ASTRO Meeting target volume delineation, 9 minutes for IMRT planning, 10 minutes for the repeat verification MV-CT, and 12 minutes for delivery of the first radiotherapy fraction. The average total time spent in the treatment room by patients was 62 minutes, and this decreased during the course of the study from over 90 minutes initially to approximately 60 minutes. The average time for our standard approach for simulation and immediate treatment for patients requiring urgent PRT with either fluoroscopy or conventional CT-simulation was 59 minutes and 92 minutes, respectively, and this excludes the time required to transfer patients between rooms and the waiting time between simulation and treatment. The IMRT dose distributions were more conformal than with the conventional approaches; with a more homogeneous dose to the target volume and a marked reduction in hotspots. This protocol was used for patients requiring single-fraction (8 patients) and short-course (15 patients receiving 2-5 fractions) PRT. The delivery quality assurance (DQA) done following the first fraction of treatment demonstrated good agreement between planned and delivered dose. Conclusions: Palliative radiotherapy with IG-IMRT using an integrated imaging-planning-treatment delivery system is efficient and convenient for patients, and compares very favorably with conventional approaches. This is one of the first such reported series of rapid one-session IG-IMRT and it has great potential for future applications, including single-fraction radiotherapy. Author Disclosure: R. Samant, None; L. Gerig, Honoraria, D. Speakers Bureau/Honoraria; L. Montgomery, Honoraria, D. Speakers Bureau/Honoraria; M. MacPherson, Honoraria, D. Speakers Bureau/Honoraria; G. Fox, None; R. MacRae, None; K. Carty, None; S. Andrusyk, None; P. Genest, None; B. Nyiri, None.
1062
Functional Interference Clusters in Cancer Patients with Bone Metastases: An Analysis of RTOG 9714
1
E. Chow , J. James2, A. Barsevick3, W. Hartsell4, C. Scarantino5, R. Ivker6, M. Roach7, J. Suh8, I. Petersen9, D. Bruner10 1 Odette Cancer Center, Toronto, ON, Canada, 2RTOG, Philadelphia, PA, 3Fox Chase Cancer Center, Cheltenham, PA, 4Good Samaritan Cancer Center, Downers Grove, IL, 5Rex Healthcare Cancer Center, Raleigh, NC, 6Newark Beth Israel Medical Center, Newark, NJ, 7UCSF Comprehensive Cancer Center, San Francisco, CA, 8Cleveland Clinic Foundation, Cleveland, OH, 9 Mayo Clinic, Rochester, MN, 10Abramson Cancer Center, Philadelphia, PA
Purpose/Objective(s): The primary objective was to explore if functional interference items in Brief Pain Inventory (BPI) clustered in cancer patients with bone metastases. Secondary objective was to determine whether such clusters (if any) changed with palliative radiotherapy (RT) between responders and non-responders. Materials/Methods: Worst pain at the treatment site and functional interference scores were assessed using BPI at baseline, 4, 8, and 12 weeks post-randomization. A principal component analysis was performed on the 7 functional interference items at all time points to determine their interrelationships. Principal components with an Eigenvalue greater than 1 or which explained more than 10% of the variance was retained. The Cronbach a statistic was used to estimate the internal consistency and reliability of the derived clusters. Results: All eligible patients enrolled in RTOG 9714 (randomized between a single 8 Gy and 30 Gy in 10 fractions) were included in the analysis. The median age was 67 years and gender distributions were approximately equal. Of the 909 patients, 445 (49%) responded to treatment within 12 weeks. Two clusters were identified at baseline. The first cluster included general activity, normal work, and walking ability and accounted for 58% of the total variance. The second cluster included enjoyment of life, mood, relations with others, and sleep and accounted for 13% of the total variance with Cronbach a statistic 0.83 and 0.80 respectively. Radiotherapy significantly improved general activity, mood, normal work, relations with others, and sleep item scores over time when adjusting for responder status. In responders, the two clusters did not persist beyond baseline. In non-responders, the general activity, normal work, and walking ability cluster remained consistent, the mood and enjoyment of life items interchanged at week 8, but the two clusters disappeared only at week 12. Conclusions: Palliative radiotherapy has been proven effective in alleviating symptomatic bone pain and reducing functional interference over time. Functional interference clusters exist in cancer patients with bone metastases. Treating pain with radiotherapy would disintegrate such clusters. Author Disclosure: E. Chow, None; J. James, None; A. Barsevick, None; W. Hartsell, None; C. Scarantino, None; R. Ivker, None; M. Roach, None; J. Suh, None; I. Petersen, None; D. Bruner, None.
1063
Multidisciplinary Team Contributions within a Rapid Access Palliative Radiotherapy Program
E. Pituskin1,2, A. Fairchild1,2, J. Dutka1, P. Tachynski1, A. Driga1, J. Borschneck1 1
Cross Cancer Institute, Edmonton, AB, Canada, 2University of Alberta, Edmonton, AB, Canada
Purpose/Objective(s): The majority of patients with bone metastases (BM) secondary to cancer experience symptoms such as pain or impaired mobility, and may require multiple medications for analgesia, with attendant side effects. Palliative-intent radiotherapy (RT) is effective in decreasing pain, but in the usual model of RT delivery, additional supportive care interventions can be overlooked. While ‘multi-disciplinary’ is a catchword often used to describe clinics in various settings, recommendations from allied health practitioners are rarely included in patients’ overall treatment plan. However, provision of such supportive care is one of the goals of the Rapid Access Palliative Radiotherapy Program (RAPRP), along with timely patient assessment and delivery of RT for BM. The purpose of this project was to determine the feasibility of multidisciplinary assessment in the setting of a rapid access outpatient RT clinic. Materials/Methods: RAPRP disciplines (Pharmacy [RX], Occupational Therapy [OT], Clinical Nutrition [CN], Social Work [SW]) developed screening forms to streamline assessment, performed consultations within the clinic, and arranged follow-up as necessary. Recommendations were included within the final treatment plan and tracked for patients attending clinic. RX and OT participated for the entire pilot (Jan-June 2007), while CN and SW joined the RAPRP team in March. Results: 58 patients with painful BM were assessed over a 25 week pilot period. Median age was 69.9 years (range, 39-86), 64% had prostate cancer, median performance status was 70. Pain was rated on average 6.1/10 at baseline and average oral morphine equivalent daily dose (MEDD) was 83 mg/24 hrs (range, 0-2000 mg). 40/58 (69%) patients were seen by RX, who completed a medical history in 90%. Based on the results of the screening tools, 19/58 (33%) patients were seen by OT, 9/58 (16%) were
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