Is Weekend Radiation Therapy Always Justified?

BACKGROUND

Patients presenting with an oncology emergency should be assessed and treated promptly to address symptoms, preserve function, and maintain quality of life. In some circumstances, this requires treatment of patients on weekends. The primary objective of this study was to review the delivery of urgent radiotherapy (RT) at our institution to determine the proportion of courses with a documented indication for which weekend RT could be justified based on comparison with published literature.

METHODS

Patients undergoing RT on weekends (January 2009-July 2009) were reviewed retrospectively for demographics, disease site, functional status, and documented reason for after-hours treatment. Data were obtained from both the electronic and paper medical records and input into an Excel spreadsheet after being anonymized. Summary statistics were calculated. A literature search was conducted to supplement the Alberta Health Services Palliative Radiotherapy clinical practice guidelines, which included review of relevant publications from the Standards and Guidelines Evidence database.

RESULTS

A total of 108 patients (73 males, 35 females) received RT to 132 sites over this period, primarily on both Saturday and Sunday (87.8%). Of these, 37.9% had a lung primary, 97.0% were treated with palliative intent, and 46.2% received spine RT. On average, 18.9 weekend treatment courses took place each month (range, 2-12). 67.1% had a planned anteroposterior field arrangement, and the dose-fractionation schedule was 2000 cGy in five fractions in the majority (68.9%). Based on the reason documented for emergency RT, 72.1% of all after-hours treatments could be justified by comparison to published literature.

CONCLUSIONS

Given resource and technical considerations, delivery of RT during weekends requires specific clinical justification. Presently at our center, decision to institute after-hours RT is at the discretion of the treating radiation oncologist. The majority of indications for weekend treatment of these patients could be justified based on published evidence.