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Novel Inpatient Radiation Oncology Consult Service Associated with Improved Prognosis-Appropriate Care
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e439-e440, 2022.
Article in English | Academic Search Complete | ID: covidwho-2036113
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.)
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Full text: Available Collection: Databases of international organizations Database: Academic Search Complete Type of study: Prognostic study Language: English Journal: International Journal of Radiation Oncology, Biology, Physics Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: Academic Search Complete Type of study: Prognostic study Language: English Journal: International Journal of Radiation Oncology, Biology, Physics Year: 2022 Document Type: Article