Palliative radiation therapy pathway for patients on hospice in a statewide quality improvement collaborative.

Authors

null

Natalia Simon

MOQC, Ann Arbor, MI

Natalia Simon, Thomas Pence Boike, Kiran Devisetty, Sam Beusterien, Kelly DeVries, Jennifer J. Griggs

Organizations

MOQC, Ann Arbor, MI, Detroit Medical Center, Petoskey, MI, McLaren Cancer Institute, Flint, Grand Blanc, MI, Michigan Oncology Quality Consortium, Ann Arbor, MI, Michigan Oncology Quality Consortium, Superior Charter Township, MI, University of Michigan, Ann Arbor, MI

Research Funding

Other
Blue Cross Blue Shield of Michigan.

Background: Patients on hospice receive care directed at alleviating symptoms with the goal of reducing burdensome and unnecessary healthcare. Single-fraction radiation therapy is an effective palliative treatment for cancer‐related bleeding. Hospice physicians and radiation oncologists are driven by the same goals of relieving symptoms and decreasing the burden of treatment. In general, hospices are not able to support the costs of providing palliative radiation in eligible patients. The inability to receive radiation therapy may pose a barrier to hospice enrollment. Methods: The Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly 90% of oncologists in Michigan, partnered with radiation oncologists, hospice directors, and patients and caregivers to create a pathway for the referral and treatment of patients with cancer-related bleeding. Through regular meetings, the collaboration created a pathway for patients on hospice or eligible for hospice who were candidates for palliative radiation therapy for bleeding. In patients with cancer-related bleeding, the hospice clinician collaborates with a participating radiation oncologist to confirm eligibility. This decreases the hospice costs of treatment, increases access to palliative radiation, and alleviates the financial and emotional burdens on the patient and family. Results: In Michigan radiation oncology practices and hospices with statewide representation approved the pathway. Radiation oncologists in 19 practices across the state agreed to high value radiation treatment (focused level 3 consultation, complex isodose planning, single fraction treatment). Eligible patients may be seen via virtual consultation and then treated within 1 to 2 days with a single fraction of 8 Gy. A second fraction can be given in patients who continue to have bleeding. MOQC established direct connection to members of the collaborative whose contact information is available on MOQC website. In addition to this treatment pathway, the previously adopted palliative radiation pathway for oncology patients with bone metastases may be found on MOQC website. Conclusions: The radiation therapy pathway for patients with bleeding ensures a unified approach to providing a patient-focused care in patients with limited life expectancy. Challenges to the implementation of the pathway include dissemination of the document across over 100 Michigan hospices and the upfront effort required to screen patients.

Screening criteria and real-life scenarios are included in the pathway to guide patient selection.

Criteria
Bleeding must be amenable to radiation therapy
Sites of bleeding: head and neck, bladder, chest wall/skin, gastrointestinal or gynecologic region
Patients with a history of bleeding in whom recurring bleeding could be expected
Stable vital signs as assessed by hospice physician
Palliative Performance Scale (PPS) of ≥ 40%

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2022 ASCO Quality Care Symposium

Session Type

Poster Session

Session Title

Poster Session B

Track

Palliative and Supportive Care,Technology and Innovation in Quality of Care,Quality, Safety, and Implementation Science

Sub Track

Palliative Care

Citation

J Clin Oncol 40, 2022 (suppl 28; abstr 201)

DOI

10.1200/JCO.2022.40.28_suppl.201

Abstract #

201

Poster Bd #

A26

Abstract Disclosures

Similar Abstracts

First Author: Anshu Hemrajani

First Author: Gunjan Sharma

Abstract

2019 ASCO Annual Meeting

A community oncology end-of-life care program: Results for hospice length of stay analysis.

First Author: Adil Jamal Akhtar

Abstract

2023 ASCO Quality Care Symposium

Characteristics of patients utilizing general inpatient (GIP) hospice.

First Author: Megha Shalavadi