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
Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by 2019-nCoV. Due to the physiological change in pregnancy, pregnant women are susceptible to COVID-19 and are at increased risk for adverse pregnancy outcomes, especially in the context of spread of novel variants. At present, less evidences have been obtained from randomized controlled trials on the effectiveness and safety of COVID-19 vaccine use in pregnant women, and the recommendations of COVID-19 vaccination for pregnant women vary with countries, posing challenge to the prevention and control of COVID-19 in pregnant women. This paper summarizes the progress in major research of 2019-nCoV infection in pregnancy conducted both at home and abroad, describes the harm of COVID-19 in pregnancy to pregnant women, fetuses and infants and introduces the effectiveness and safety of COVID-19 vaccination in pregnancy revealed by real world studies in order to provide reference for the related research and development of COVID-19 prevention and control strategies in pregnant women.