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Outcomes After Intensive Care Unit Admission for Patients Receiving Palliative Radiation Therapy: A Missed Opportunity for Goals of Care Discussions
E508
International Journal of Radiation Oncology Biology Physics
were described using Kaplan-Meier methods with 95% confidence intervals. Results: There were 187 treatments delivered in 133 patients during the study period. The median age of patients was 65. The most common primary malignancies were prostate cancer (nZ34 patients), colorectal cancer (nZ25), lung cancer (nZ24) and bone and soft tissue sarcomas (nZ15). The two main target sites treated were lung (51%) and bone (41%). The common prescription doses were 26 Gy /1# (47%), 20 Gy /1# (34%) and 24 Gy/1# (10%). The freedom from local progression at 1 year was 90% (95% CI 84% - 95%) and 2 years 84% (95% CI 76% 92%). The freedom from distant progression was 52% at 1 year (95% CI 43% - 62%) and 39% at 2 years (95% CI 30% - 51%). The freedom from widespread disease was 74% at 1 year (95% CI 67% - 83%) and 60% at 2 years (95% CI 50% - 73%). The freedom from widespread disease after salvage SABR for further distant progression was 72% at 6 months (95% CI 60% - 88%) and 68% at 12 months (95% CI 54% 86%). The 1 year overall survival was 99% (95% CI 97% - 100%) and 2 year overall survival was 87% (95% CI 79% - 97%). No Grade 3 or higher treatment related toxicity was reported, with 94 patients (50.8%) not suffering any toxicity. Conclusion: Single fraction SABR is associated with a high rate of freedom from widespread disease, excellent local control, favorable overall survival, and low toxicity profile. Single fraction SABR is a resource efficient treatment that may delay the need for active systemic treatment in patients with oligometastatic disease. Author Disclosure: S. Gandhidasan: None. M. Bressel: None. T. Kron: None. M. Shaw: None. J. Chu: None. S. Chander: None. G. Wheeler: None. N. Plumridge: None. B. Chesson: None. A. Haworth: None. S.P. David: None. D. Ball: None. S. Siva: None.
Conclusion: ICU admission in patients with advanced cancer treated with palliative radiation therapy is associated with poor outcomes. Almost half of the patients with metastatic cancer in this study either died during the hospitalization or were discharged with hospice care, and few were able to receive any further cancer directed therapy after ICU admission. These results point to the palliative radiation consultation as an underutilized opportunity to address goals of care and advanced directives with patients and their families. Author Disclosure: S. Rakhra: None. R. Sacotte: None. F. Wehbe: None. J.M. Kruser: None. D. Liu: None. T. Kruser: None.
3247 Outcomes After Intensive Care Unit Admission for Patients Receiving Palliative Radiation Therapy: A Missed Opportunity for Goals of Care Discussions S. Rakhra,1 R. Sacotte,2 F. Wehbe,3 J.M. Kruser,4 D. Liu,5 and T. Kruser1; 1 Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, 2Feinberg School of Medicine, Northwestern University, Chicago, IL, 3Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 4 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 5Northwestern University Cancer Biostatistics, Chicago, IL Purpose/Objective(s): Characterize outcomes of patients with advanced cancer treated with palliative radiation therapy who are subsequently admitted to an intensive care unit (ICU). Materials/Methods: We identified 271 patients at a single tertiary academic center with bone (62.7%) or brain (37.3%) metastases who were treated with palliative radiation therapy and subsequently admitted to an ICU between January 1, 2005, and December 31, 2015. The primary outcome measure was median survival after ICU admission. Secondary outcome measures included discharge disposition and receipt of additional cancer directed therapy following admission to ICU. Results: The patients were 51.3% female and the median age of ICU admission was 60 years (range 20 to 92 years). The most frequent sites of primary malignancy were lung (22.4%) and breast (19.0%). Patients received palliative radiation therapy to the following sites (including patients with more than one site of radiation): bone (55.0%), brain (41.0%), lung (5.9%), and other (5.5%). The median radiation dose was 30 Gy (range 3 to 60 Gy), and the median number of radiation fractions was 10 (range 1 to 30). After ICU admission, 42.4% of patients died during the hospitalization, 37.6% were discharged home, 12.5% of patients were discharged to a long-term care facility, 6.6% of patients were discharged to hospice, and 1.1% had other dispositions. Median survival from the date of ICU admission was 23 days. Most patients (82.0%) received no further cancer-directed therapy after ICU admission.
3248 Radiation Therapy Fractionation Practice Patterns in End-of-Life Care S. Aggarwal,1 N.D. Prionas,2 J.N. Carter,3 K.A. Kumar,1 P. Pradhan,3 J.L. Bui,3 R. von Eyben,3 A.C. Koong,1 and D.T. Chang4; 1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, 2Stanford University Department of Radiation Oncology, Stanford, CA, 3Stanford University, Stanford, CA, 4Stanford University School of Medicine, Department of Radiation Oncology, Stanford, CA Purpose/Objective(s): Radiation therapy is commonly used for palliation for metastatic disease. However, during end-of-life care, optimizing the benefit of intervention with the cost of time and inconvenience receiving palliative therapy is important. The purpose of this study is to evaluate the patterns of use of various fractionation schemes used for palliation of patients with metastatic disease. Materials/Methods: We prospectively enrolled 242 patients with metastatic disease who were treated with palliative external beam radiation therapy (EBRT) at our institution from March through December 2015. In total, 69 patients died and were eligible for evaluation. Fractionation was binned as <5 (short), 5-9 (intermediate), or 10 (long) fractions. Common fractionation schedules used were 8 Gy in 1 fraction (83%) for the short group, 20 Gy in 5 fractions (89%) in the intermediate group, and 30 Gy in 10 fractions (62%) in the long group. For 7 patients (10%), palliative radiation was delivered to a previously irradiated site, 0 (0%), 3 (43%), and 4 (57%) of whom received short, intermediate, and long fractionations, respectively. Results: The median follow-up was 3.4 months. Of the 69 deceased patients, 12 (17%), 18 (26%), and 39 (57%) were prescribed short, intermediate, and long fractionation schemes, respectively. For patients that died within 3 months of radiation, 23%, 30%, and 46% received short, intermediate, and long fractionation, respectively. For patients that died 4-6 months after receiving radiation, 6%, 16%, and 78% received each scheme. For patients that died >6 months after receiving radiation, 0%, 20%, and 80% were prescribed each fractionation scheme. The difference in schedule for these patients was statistically significant (P < 0.001). For the 62 patients who died >6 months from receiving radiation or are living with >6 months of follow-up, 4 (7%), 15 (25%), and 43 (68%) were prescribed short, intermediate, and long fractionation schemes, respectively. For patients who died within 6 months of treatment, those who received short radiotherapy were treated on 3% of their remaining days alive, those who received intermediate radiotherapy were treated on 19% of their remaining days alive, and those who received long radiotherapy were treated on 23% of their remaining days alive. Seven patients (2.9%) required subsequent re-irradiation to the same site since this study started. Conclusion: While patients who lived a shorter amount of time after palliative EBRT were more likely to be prescribed a shorter fractionation scheme, the time spent at end-of-life undergoing radiotherapy suggests that short fractionation schemes should be integrated more into clinical practice to reduce the burden of treatment on these patients. Improved understanding of prognosis and better selection of treatment schedule is needed to optimize the utilization of palliative radiation.
International Journal of Radiation Oncology Biology Physics
were described using Kaplan-Meier methods with 95% confidence intervals. Results: There were 187 treatments delivered in 133 patients during the study period. The median age of patients was 65. The most common primary malignancies were prostate cancer (nZ34 patients), colorectal cancer (nZ25), lung cancer (nZ24) and bone and soft tissue sarcomas (nZ15). The two main target sites treated were lung (51%) and bone (41%). The common prescription doses were 26 Gy /1# (47%), 20 Gy /1# (34%) and 24 Gy/1# (10%). The freedom from local progression at 1 year was 90% (95% CI 84% - 95%) and 2 years 84% (95% CI 76% 92%). The freedom from distant progression was 52% at 1 year (95% CI 43% - 62%) and 39% at 2 years (95% CI 30% - 51%). The freedom from widespread disease was 74% at 1 year (95% CI 67% - 83%) and 60% at 2 years (95% CI 50% - 73%). The freedom from widespread disease after salvage SABR for further distant progression was 72% at 6 months (95% CI 60% - 88%) and 68% at 12 months (95% CI 54% 86%). The 1 year overall survival was 99% (95% CI 97% - 100%) and 2 year overall survival was 87% (95% CI 79% - 97%). No Grade 3 or higher treatment related toxicity was reported, with 94 patients (50.8%) not suffering any toxicity. Conclusion: Single fraction SABR is associated with a high rate of freedom from widespread disease, excellent local control, favorable overall survival, and low toxicity profile. Single fraction SABR is a resource efficient treatment that may delay the need for active systemic treatment in patients with oligometastatic disease. Author Disclosure: S. Gandhidasan: None. M. Bressel: None. T. Kron: None. M. Shaw: None. J. Chu: None. S. Chander: None. G. Wheeler: None. N. Plumridge: None. B. Chesson: None. A. Haworth: None. S.P. David: None. D. Ball: None. S. Siva: None.
Conclusion: ICU admission in patients with advanced cancer treated with palliative radiation therapy is associated with poor outcomes. Almost half of the patients with metastatic cancer in this study either died during the hospitalization or were discharged with hospice care, and few were able to receive any further cancer directed therapy after ICU admission. These results point to the palliative radiation consultation as an underutilized opportunity to address goals of care and advanced directives with patients and their families. Author Disclosure: S. Rakhra: None. R. Sacotte: None. F. Wehbe: None. J.M. Kruser: None. D. Liu: None. T. Kruser: None.
3247 Outcomes After Intensive Care Unit Admission for Patients Receiving Palliative Radiation Therapy: A Missed Opportunity for Goals of Care Discussions S. Rakhra,1 R. Sacotte,2 F. Wehbe,3 J.M. Kruser,4 D. Liu,5 and T. Kruser1; 1 Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, 2Feinberg School of Medicine, Northwestern University, Chicago, IL, 3Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 4 Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 5Northwestern University Cancer Biostatistics, Chicago, IL Purpose/Objective(s): Characterize outcomes of patients with advanced cancer treated with palliative radiation therapy who are subsequently admitted to an intensive care unit (ICU). Materials/Methods: We identified 271 patients at a single tertiary academic center with bone (62.7%) or brain (37.3%) metastases who were treated with palliative radiation therapy and subsequently admitted to an ICU between January 1, 2005, and December 31, 2015. The primary outcome measure was median survival after ICU admission. Secondary outcome measures included discharge disposition and receipt of additional cancer directed therapy following admission to ICU. Results: The patients were 51.3% female and the median age of ICU admission was 60 years (range 20 to 92 years). The most frequent sites of primary malignancy were lung (22.4%) and breast (19.0%). Patients received palliative radiation therapy to the following sites (including patients with more than one site of radiation): bone (55.0%), brain (41.0%), lung (5.9%), and other (5.5%). The median radiation dose was 30 Gy (range 3 to 60 Gy), and the median number of radiation fractions was 10 (range 1 to 30). After ICU admission, 42.4% of patients died during the hospitalization, 37.6% were discharged home, 12.5% of patients were discharged to a long-term care facility, 6.6% of patients were discharged to hospice, and 1.1% had other dispositions. Median survival from the date of ICU admission was 23 days. Most patients (82.0%) received no further cancer-directed therapy after ICU admission.
3248 Radiation Therapy Fractionation Practice Patterns in End-of-Life Care S. Aggarwal,1 N.D. Prionas,2 J.N. Carter,3 K.A. Kumar,1 P. Pradhan,3 J.L. Bui,3 R. von Eyben,3 A.C. Koong,1 and D.T. Chang4; 1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, 2Stanford University Department of Radiation Oncology, Stanford, CA, 3Stanford University, Stanford, CA, 4Stanford University School of Medicine, Department of Radiation Oncology, Stanford, CA Purpose/Objective(s): Radiation therapy is commonly used for palliation for metastatic disease. However, during end-of-life care, optimizing the benefit of intervention with the cost of time and inconvenience receiving palliative therapy is important. The purpose of this study is to evaluate the patterns of use of various fractionation schemes used for palliation of patients with metastatic disease. Materials/Methods: We prospectively enrolled 242 patients with metastatic disease who were treated with palliative external beam radiation therapy (EBRT) at our institution from March through December 2015. In total, 69 patients died and were eligible for evaluation. Fractionation was binned as <5 (short), 5-9 (intermediate), or 10 (long) fractions. Common fractionation schedules used were 8 Gy in 1 fraction (83%) for the short group, 20 Gy in 5 fractions (89%) in the intermediate group, and 30 Gy in 10 fractions (62%) in the long group. For 7 patients (10%), palliative radiation was delivered to a previously irradiated site, 0 (0%), 3 (43%), and 4 (57%) of whom received short, intermediate, and long fractionations, respectively. Results: The median follow-up was 3.4 months. Of the 69 deceased patients, 12 (17%), 18 (26%), and 39 (57%) were prescribed short, intermediate, and long fractionation schemes, respectively. For patients that died within 3 months of radiation, 23%, 30%, and 46% received short, intermediate, and long fractionation, respectively. For patients that died 4-6 months after receiving radiation, 6%, 16%, and 78% received each scheme. For patients that died >6 months after receiving radiation, 0%, 20%, and 80% were prescribed each fractionation scheme. The difference in schedule for these patients was statistically significant (P < 0.001). For the 62 patients who died >6 months from receiving radiation or are living with >6 months of follow-up, 4 (7%), 15 (25%), and 43 (68%) were prescribed short, intermediate, and long fractionation schemes, respectively. For patients who died within 6 months of treatment, those who received short radiotherapy were treated on 3% of their remaining days alive, those who received intermediate radiotherapy were treated on 19% of their remaining days alive, and those who received long radiotherapy were treated on 23% of their remaining days alive. Seven patients (2.9%) required subsequent re-irradiation to the same site since this study started. Conclusion: While patients who lived a shorter amount of time after palliative EBRT were more likely to be prescribed a shorter fractionation scheme, the time spent at end-of-life undergoing radiotherapy suggests that short fractionation schemes should be integrated more into clinical practice to reduce the burden of treatment on these patients. Improved understanding of prognosis and better selection of treatment schedule is needed to optimize the utilization of palliative radiation.