Gutt Ruchika, Malhotra Sheetal, Hagan Michael P, Lee Steve P, Faricy-Anderson Katherine, Kelly Maria D, Hoffman-Hogg Lori, Solanki Abhishek A, Shapiro Ronald H, Fosmire Helen, Moses Edwinette, Dawson George A
Washington DC VA Medical Center, Washington, DC.
The Southeast Permanente Medical Group, Jonesboro, GA.
JCO Oncol Pract. 2021 Dec;17(12):e1913-e1922. doi: 10.1200/OP.20.00981. Epub 2021 Mar 18.
Most Veterans Health Administration hospitals do not have radiation oncology (RO) departments on-site. The purpose of this study is to determine the impact of on-site RO on referral patterns and timeliness of palliative radiation therapy (PRT).
A survey was sent to medical directors at 149 Veterans Health Administration centers. Questions evaluated frequency of referral for PRT, timeliness of RO consults and treatment, and barriers to referral for PRT. Chi-square analysis was used to evaluate differences between centers that have on-site RO and centers that refer to outside facilities.
Of 108 respondents, 33 (31%) have on-site RO. Chi-square analysis revealed that RO consult within 1 week is more likely at centers with on-site RO (68% 31%; = .01). Centers with on-site RO more frequently deliver PRT for spinal cord compression within 24 hours (94% 70%; = .01). Those without on-site RO were more likely to want increased radiation oncologist involvement (64% 26%; < .001). Barriers to referral for PRT included patient ability to travel (81%), patient noncompliance (31%), delays in consult and/or treatment (31%), difficulty contacting a radiation oncologist (14%), and concern regarding excessive number of treatments (13%). Respondents with on-site RO less frequently reported delays in consult and/or treatment (6% 41%; < .0001) and difficulty contacting a radiation oncologist (0% 20%; = .0056) as barriers.
Respondents with on-site RO reported improved communication with radiation oncologists and more timely consultation and treatment initiation. Methods to improve timeliness of PRT for veterans at centers without on-site RO should be considered.
大多数退伍军人健康管理局医院没有现场放射肿瘤学（RO）科室。本研究的目的是确定现场RO对姑息性放射治疗（PRT）转诊模式和及时性的影响。
向149个退伍军人健康管理中心的医疗主任发送了一份调查问卷。问题评估了PRT的转诊频率、RO会诊和治疗的及时性以及PRT转诊的障碍。采用卡方分析来评估有现场RO的中心和转诊至外部机构的中心之间的差异。
在108名受访者中，33名（31%）有现场RO。卡方分析显示，有现场RO的中心在1周内进行RO会诊的可能性更高（68%对31%；P =.01）。有现场RO的中心更频繁地在24小时内为脊髓压迫患者提供PRT（94%对70%；P =.01）。没有现场RO的中心更希望增加放射肿瘤学家的参与（64%对26%；P <.001）。PRT转诊的障碍包括患者的出行能力（81%）、患者不依从（31%）、会诊和/或治疗延迟（31%）、联系放射肿瘤学家困难（14%）以及对治疗次数过多的担忧（13%）。有现场RO的受访者较少将会诊和/或治疗延迟（6%对41%；P <.0001）和联系放射肿瘤学家困难（0%对20%；P =.0056）报告为障碍。
有现场RO的受访者报告称与放射肿瘤学家的沟通得到改善，会诊和治疗开始更及时。应考虑采取措施提高没有现场RO的中心为退伍军人进行PRT的及时性。
