Beth Israel Deaconess Medical Center, Boston, MA
Lauren Michelle Hertan, Alexandra Nichipor, Yaseer Mohammed Khouj, Cierra Zaslowe-Dude, Tracy A. Balboni, Monica Shalini Krishnan
Background: Radiation is often used to palliate symptoms in patients with advanced cancer and the number of fractions used can vary significantly from as short as a single fraction (SF) to up to a multiple week course. No data currently exists regarding demographic factors and their influence on survival and fractionation decisions. The aim of this project is to investigate the association of demographic factors with survival, likelihood of SF use in patients (pts) receiving RT for bone metastases, and likelihood of hypofractionation (HF) (≤ 5 fx) in pts being treated for any palliative reason, excluding those receiving partial brain RT (PBRT) which includes stereotactic radiosurgery, and stereotactic radiation therapy. Methods: We retrospectively reviewed charts of pts treated with palliative RT between 1/2015 – 5/2017 at 2 tertiary centers and 4 community satellite practices. Demographic factors analyzed are included in table 1. Logistic regression was used to evaluate the associations between the factors and outcomes. Results: A total of 928 pts were included in the survival analysis. In the two subset analyses, 373 pts were included in the bone metastasis analysis and 745 were included in the analysis of all patients excluding pts receiving PBRT. In pts treated for bone metastases, consult type (inpatient vs. outpatient) was the only significant factor on multivariate analysis, with inpatient consults being more likely to get SF (HR = 2.169, =.025). In the pts receiving palliative RT (excluding PBRT), race and consult location (tertiary vs. community) were significant. Non-white pts (HR=0.527, p=.012) and pts treated in the community (HR=.778, p<.001) were less likely to get HF. Gender (male vs. female), consult location (tertiary vs. community), and consult type (inpatient vs. outpatient) were significant on multivariate analysis for survival (HR=1.243, p=.028; HR=1.602, p<.001; HR=2.301, p<.001, respectively). Conclusions: This analysis suggests that demographic factors may affect both survival and decision making regarding fractionation in patients receiving palliative radiation. Further investigation into the reasons for these differences is needed.
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