ABSTRACT
Radiation therapy has an increasing role in the management of patients with metastatic cancer. The integration of ablative versus palliative techniques with surgical and systemic approaches is complex, and inefficient care delivery can lead to prolonged hospitalizations that are inconsistent with palliative goals. A dedicated Inpatient Radiation Oncology Consult (IROC) service was created to provide rapid access to palliative radiotherapy. We previously reported the short-term impact of the IROC service in reducing hospital length of stay (LOS), and here we provide an update on long-term improvements in patient care, focusing on quality-of-care metrics including hospital LOS, use of hypofractionated approaches, and prognosis-appropriate care. We retrospectively compared inpatient radiation oncology consults placed in the 12 months preceding IROC (N = 1,507) to those placed during a 12-month period after IROC implementation (N = 1,509). The dates for calendar-matched cohorts were selected to minimize potential confounding from practice changes related to the first peak of the COVID-19 pandemic. We analyzed continuous variables using the Mann-Whitney test and categorical variables using the Fisher's exact test. The IROC service was associated with reduced hospital length of stay for all consults (mean difference 1.0 day, P = 0.045). IROC led to shorter inpatient radiotherapy courses (mean 5.8 vs. 5.0 days, P = 0.007, and this reduction was greatest for patients discharged to hospice (mean 5.2 vs. 3.7 days, P = 0.033). Compared to pre-IROC patients, IROC patients were more likely to receive hypofractionated treatment (≤ 5 fractions;pre-IROC, N = 405/551 (74%) vs. IROC, N = 433/528 (82%), P = 0.001). Notably, the trend toward fewer prescribed fractions was not due to increased uptake of inpatient stereotactic regimens (N = 84/551 (15%) vs. N = 87/528 (16%), pre-IROC vs. IROC, respectively, P = 0.560). Death within 60 days of inpatient radiation therapy decreased under IROC (pre-IROC, N = 227/551 (41%) vs. IROC, N = 184/528 (35%), P = 0.033). A dedicated inpatient radiation oncology consult (IROC) service was associated with long-term reductions in hospital length of stay. Prognosis-appropriate care was improved through shorter treatment courses and decreased delivery of radiation to patients discharged to hospice or with limited survival. Our findings demonstrate the value of a dedicated program addressing the appropriate delivery of radiotherapy to hospitalized patients and highlight opportunities to stratify patients appropriate for ablative versus palliative treatments. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Purpose or Objective Radiation therapy has an expanding role in the management of patients with advanced cancers, including in the palliative and oligometastatic settings. We previously described an inpatient radiation oncology consult (IROC) service created to deliver rapid, specialized metastatic cancer care to hospitalized patients. Here we report an 18-month update on IROC patient outcomes to test the hypothesis that IROC decreased hospital length of stay (LOS) and led to more prognosis-appropriate care, including during the first peak of the COVID-19 pandemic. Materials and Methods The IROC service started in January 2020 and comprises faculty, advanced practice providers, nurses and resident trainees. Faculty are specialists in palliative and metastatic cancer care with certification in ablative radiation techniques. We compared inpatient radiation oncology consults placed from January to December 2019 (pre-IROC, N = 1,507) to those placed from June 2020 to June 2021 (IROC, N = 1,509). In a separate analysis, we examined consults during a non-overlapping period from March to June 2020 (N = 302) to assess changes in IROC practice patterns related to the peak of the COVID-19 pandemic in New York City. Statistical significance was assessed using the Mann-Whitney test. Results Hospital LOS decreased among all inpatient radiation oncology consult patients after implementation of IROC (N = 1,509 patients) by an average of 1.0 day compared to patients treated prior to IROC (N = 1,507 patients;P = 0.045). With IROC, consults were staffed an average of 0.6 days sooner (P < 0.001). Death within 60 days of inpatient RT decreased under IROC (35.4%, N = 187/528 patients) compared to prior (43.7%, N =241/551 patients, P = 0.005). Among patients discharged to hospice, inpatient treatment duration decreased after IROC (median 4 vs. 2 days, pre-IROC (N = 64 patients) vs. IROC (N = 82 patients), respectively, P = 0.033). The IROC service received consults for 21 patients infected with SARS-CoV-2, and 17 patients had active COVID-19 during treatment. Notably, hospital LOS for patients receiving inpatient RT under IROC was significantly shorter during the COVID-19 peak (median LOS 9 days, P < 0.001), when time to treatment decreased by an (Figure Presented) Conclusion A dedicated inpatient radiation oncology consult (IROC) service was associated reduced hospital LOS, faster care delivery, and more prognosis-appropriate care. It enabled rapid implementation of emergency RT guidelines, including abbreviated treatment durations, during the first COVID-19 peak in a pandemic hotspot