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Location: Marriott Marquis
Location: Marriott Marquis
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PQA 04 - PQA 04 Palliative Care and Central Nervous System Poster Q&A

2514 - Long-Term Impact of a High-Volume Inpatient Radiation Oncology Consult Service on Cancer Care Delivery

Monday, September 30, 2024
10:45 AM – 12:00 PM ET
Location: Hall C

Screen: 17

M. E. Freret1, D. Yerramilli1, V. S. Brennan1, L. A. Boe2, S. N. Powell1, S. M. McBride1, P. Iyengar1, D. R. Gomez1, and A. J. Xu1; 1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 2Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): Radiotherapy plays an important role in the management of patients with advanced cancers. A dedicated Inpatient Radiation Oncology Consult (IROC) service was started on January 6, 2020, to deliver rapid, specialized radiotherapy to hospitalized cancer patients. We previously reported the short-term impact of the IROC service on health care resource use, efficiency of care delivery, and end-of-life radiotherapy practices, however these results were potentially confounded by COVID-19 pandemic-related practice variations. Here we investigated long-term IROC outcomes to test the hypothesis that IROC continued to improve the quality of care for advanced cancer patients with shorter radiation treatment schedules and decreased delivery of futile care. Materials/

Methods: All patients had radiation oncology consult orders placed while admitted to a single tertiary-care hospital between 2019 and 2024. We compared outcomes between consult patients treated during a 12-month period before IROC implementation (pre-IROC, n = 1,490) to those placed during the first 48 months of the IROC service (n = 6,398), corresponding to 7,888 radiation oncology consults for 5,842 unique patients. We analyzed continuous variables using the Mann-Whitney test and categorical variables using the Fisher’s exact test. Statistical significance tests were two-sided and used a = 0.05.
Results: Comparing all consults, IROC consults were associated with shorter hospital stays compared to the pre-IROC period (mean difference 1.1 days, P < 0.001). IROC consults were staffed by an attending radiation oncologist on average 0.6 days sooner (P < 0.001). Patients who underwent inpatient radiotherapy had shorter treatment courses under IROC (n = 2,144) compared to pre-IROC (n = 556; mean difference 1.0 days, P < 0.001). IROC patients were more likely to complete their planned inpatient radiotherapy courses (completion rate pre-IROC, n = 481/556, 86.5% vs. IROC, n = 1,920/2,144, 90.0%, P = 0.048). Furthermore, patients who died during admission were less likely to receive radiotherapy under IROC (pre-IROC, n = 76/151, 50.3% vs. IROC, n = 208/520, 40.0%, P = 0.025).
Conclusion: In this long-term analysis, a dedicated inpatient radiation oncology consult service was associated with shorter hospital stays, more timely care, and decreased radiation delivery to patients at the end of life. Our findings suggest that a care model that prioritizes rapid staffing of inpatient specialty consults by radiation oncologists with expertise in metastatic cancer care leads to sustained improvements in care efficiency and decreased delivery of medically futile care.