Departments of Radiation Therapy and Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Curr Oncol. 2009 Aug;16(4):55-60. doi: 10.3747/co.v16i4.352.
Radiotherapy for oncologic emergencies is an important aspect of the management of cancer patients. These emergencies-which include malignant spinal cord compression, brain metastases, superior vena cava obstruction, and uncontrolled tumour hemorrhage -may require treatment outside of hospital hours, particularly on weekends and hospital holidays. To date, there remains no consensus among radiation oncologists regarding the indications and appropriateness of radiotherapy treatment on weekends, and treatment decisions remain largely subjective. The main aim of the present study was to document the incidence and indications for patients receiving emergency treatment on weekends or scheduled hospital holidays at a single institution. The secondary aim was to investigate the compliance of such treatment with the institution's quality assurance policies, both local and provincial.
From September 1, 2002, to September 30, 2004, patients being treated over weekends (defined as commencing at 6 pm on a Friday and concluding at 8 am of the next scheduled workday) and hospital holidays were retrospectively identified using the Oncology Patient Information System scheduling module. Relevant patient data-including patient age, sex, primary cancer site, specific radiation field, rationale for treatment, referring hospital, total treatment dose, radiation dose fractionation, inpatient or outpatient status, and duration of treatment-were collected and subsequently analyzed. Comparison to local policy was performed subjectively.
Over the 2-year period, 161 patients were prescribed urgent radiotherapy over a weekend or on a hospital holiday. Of this cohort, 68% were treated on both Saturday and Sunday, 22% on Saturday alone, and 10% on Sunday alone. Most patients presented with lung (31%), prostate (18%), and breast cancer (17%). The top reasons for referral for emergency weekend treatment included spinal cord compression (56%), brain metastases (15%), and superior vena cava obstruction (6%). Most of the indications for treatment generally followed the quality assurance policies implemented both locally and provincially.
Patients treated over a weekend or on a hospital holiday were generally found to be treated with appropriate intent. Most treatment indications within this study both complied with provincial policy and showed a pattern of care similar to that seen in other studies in the literature. Local policy appears to be robust; however, policy improvements may allow for more cohesiveness across radiation oncologists in patterns of care in this important group of patients. Comparisons with practice at other institutions would be valuable and also a key step in developing sound guidelines for all members of the radiotherapy community to follow.
肿瘤急症的放射治疗是癌症患者治疗的一个重要方面。这些急症包括恶性脊髓压迫、脑转移、上腔静脉阻塞和无法控制的肿瘤出血，可能需要在医院工作时间以外进行治疗，尤其是在周末和医院假日。迄今为止，放射肿瘤学家在周末进行放射治疗的适应证和适当性方面仍未达成共识，治疗决策在很大程度上仍然是主观的。本研究的主要目的是记录在单一机构接受周末紧急治疗或计划医院假日治疗的患者的发生率和适应证。次要目的是调查这种治疗是否符合机构的质量保证政策，包括本地和省级政策。
从 2002 年 9 月 1 日至 2004 年 9 月 30 日，使用肿瘤患者信息系统预约模块回顾性确定在周末（定义为周五下午 6 点开始，下一个工作日上午 8 点结束）和医院假日期间接受治疗的患者。收集了相关患者数据，包括患者年龄、性别、原发癌部位、具体放射野、治疗理由、转诊医院、总治疗剂量、放射剂量分割、住院或门诊状态以及治疗持续时间，并随后进行了分析。通过主观比较与本地政策。
在 2 年期间，161 名患者在周末或医院假日接受了紧急放射治疗。在这一组中，68%的患者在周六和周日接受治疗，22%的患者仅在周六接受治疗，10%的患者仅在周日接受治疗。大多数患者患有肺癌（31%）、前列腺癌（18%）和乳腺癌（17%）。周末紧急治疗的主要转诊原因包括脊髓压迫（56%）、脑转移（15%）和上腔静脉阻塞（6%）。本研究中的大多数治疗适应证通常符合本地和省级实施的质量保证政策。
在周末或医院假日接受治疗的患者通常被认为是有适当治疗意图的。本研究中的大多数治疗适应证既符合省级政策，又与文献中的其他研究相似，表明治疗模式相似。当地政策似乎很健全；然而，政策改进可能会使更多的放射肿瘤学家在这个重要的患者群体中对治疗模式有更强的一致性。与其他机构的做法进行比较将是有价值的，也是为所有放射治疗社区成员制定合理指南的关键步骤。
