1 Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital , New York, New York.
2 Centre for Health Policy and Management, Trinity College , Dublin, Ireland .
J Palliat Med. 2018 Apr;21(4):438-444. doi: 10.1089/jpm.2017.0372. Epub 2017 Nov 30.
Palliative radiation therapy (PRT) is a commonly utilized intervention for symptom palliation among patients with metastatic cancer, yet it is under-recognized as a distinct area of subspecialty within radiation oncology.
We developed a multidisciplinary service model within radiation oncology called the Palliative Radiation Oncology Consult (PROC) service to improve the quality of cancer care for advanced cancer patients. We assessed the service's impact on patient-related and healthcare utilization outcomes.
Patients were included in this observational cohort study if they received PRT at a single tertiary care hospital between 2009 and 2017. We compared outcomes of patients treated after (post-intervention group) to those treated before (control group) PROC's establishment using unadjusted and propensity score adjusted analyses.
Of the 450 patients in the cohort, 154 receive PRT pre- and 296 after PROC's establishment. In comparison to patients treated pre-PROC, post-PROC patients were more likely to undergo single-fraction radiation (RR: 7.74, 95% CI: 3.84-15.57) and hypofraction (2-5 fraction) radiation (RR: 10.74, 95% CI: 5.82-19.83), require shorter hospital stays (21 vs. 26.5 median days, p = 0.01), and receive more timely specialty-level palliative care (OR: 2.65, 95% CI: 1.56-4.49). Despite shortened treatments, symptom relief was similar (OR: 1.35, 95% CI: 0.80-2.28).
The PROC service was associated with more efficient radiation courses, substantially reduced hospital length of stays, and more timely palliative care consultation, without compromising symptom improvements. These results suggest that a multidisciplinary care delivery model can lead to enhanced quality of care for advanced cancer patients.
姑息性放射治疗（PRT）是一种常用于缓解转移性癌症患者症状的方法，但在放射肿瘤学领域，它尚未被公认为一个独特的亚专科领域。
我们在放射肿瘤科内建立了一种多学科服务模式，称为姑息性放射肿瘤咨询（PROC）服务，以提高晚期癌症患者的癌症护理质量。我们评估了该服务对患者相关和医疗保健利用结果的影响。
如果患者在 2009 年至 2017 年期间在一家三级保健医院接受 PRT，则将其纳入本观察性队列研究。我们使用未调整和倾向评分调整分析比较了 PROC 建立前后（干预后组和对照组）患者的结局。
在队列中的 450 名患者中，有 154 名患者在 PROC 建立前接受了 PRT，296 名患者在 PROC 建立后接受了 PRT。与接受 PROC 前治疗的患者相比，接受 PROC 后治疗的患者更有可能接受单次放疗（RR：7.74，95%CI：3.84-15.57）和少分次放疗（2-5 分次）（RR：10.74，95%CI：5.82-19.83），住院时间更短（21 天与 26.5 天中位数，p=0.01），并且更及时地接受专业水平的姑息治疗（OR：2.65，95%CI：1.56-4.49）。尽管治疗时间缩短，但症状缓解相似（OR：1.35，95%CI：0.80-2.28）。
PROC 服务与更有效的放射治疗方案相关联，大大缩短了住院时间，并更及时地提供姑息治疗咨询，而不会影响症状改善。这些结果表明，多学科护理提供模式可以提高晚期癌症患者的护理质量。
