Aims
This project established a benchmark to guide best practice for 30 day mortality for patients receiving palliative radiation therapy (PRT) by completing a world-wide systematic review and meta-analysis. Using the results from this meta-analysis as a benchmark, the first population-wide retrospective review for Queensland cancer patients receiving PRT was performed.
Methods
Data was obtained from the Queensland Oncology Repository with the study population selected from Queensland cancer decedents who died between 2008-2017 and received PRT prior to their death (n=22,501). From this population, the focus was on patients receiving PRT within 30 days of death (n=4,997), and the fractionation schedules received.
Results
22% of decedents received PRT within 30 days of death with a range between 17% and 29% for individual RT treating facilities, compared with 16%, the benchmark established from the meta-analysis. Patients with lung, hepatobiliary or endocrine cancers were more likely to die within 30 days of PRT. Of those that received PRT within 30 days of death, 73% received fractionation schedules of <5 fractions. Variation in practice was observed with 39% of patients receiving >5 fractions when treated by private providers, compared with 16% for public providers.
Characteristics of decedents receiving high fractionation schedules include: 63% male, 30% aged 75+ years, 27% with a disadvantaged socioeconomic status, 66% from a metropolitan area. 30 day mortality following PRT was highest for decedents where disease duration was ≤3 months.
Trends from 2008 – 2017 indicate a decrease in the 30 day mortality rate from 25% to 20%.
Conclusion
The introduction of the benchmark for 30 day mortality following PRT, along with population wide analysis provides the foundation to enable Qld cancer services to review clinical practice, instigate local and ongoing audit, and implement practice guidelines and education. This clinical engagement helps ensure best practice care for Queenslanders with cancer.