3150 - Treatment Terminations during Radiation Therapy: A Decade of Genitourinary Terminations

B. S. Chitti¹, J. D. Nosrati¹, L. Potters¹, B. Parashar², and W. C. Chen¹; ¹Northwell, New Hyde Park, NY, ²Northwell, Lake Success, NY

Purpose/Objective(s): Disruptions in cancer care adversely affect patient outcomes, particularly when a patient does not finish the prescribed course of treatment. The impact of treatment termination (TT) during radiation therapy is not well studied. This study addresses TT for patients with genitourinary (GU) cancers in our large multi-center department over the past decade. Materials/

Methods: TT of patients undergoing radiation treatment from 2013-2022 were prospectively tracked as part of departmental quality and safety monitoring. A TT was defined as the discontinuation of radiation therapy at any point following consent and treatment planning. Top causes for TT in patients with GU cancers (bladder, prostate, kidney) were characterized into broad categories: Toxicity related PD, Nontoxicity related PD, Toxicity related CD, Nontoxicity related CD, Hospice/Expired, Disease Progression, or Unknown/Other (PD = Patient decided to terminate; CD = Clinician decided to terminate). Information on other treatment modalities was also recorded.
Results: A total of 57 TTs were identified, reflecting 2.5% of 2299 GU cancer patients simulated from 2013-2022. 33/57 TTs were of bladder cancer treatment (10/33 underwent chemoRT and 4/33 underwent TURBT), and 24/57 for prostate cancer (2/24 received androgen deprivation therapy). 17/57 patients (29%) received 0 RT fractions, with 14 (82%) simulated with curative, and 3 (18%) with palliative intent. Mean age was 76 years (IQR 52-97). 35/57 patients (61.4%) were simulated with curative intent, while 22 (38.6%) were simulated with palliative intent.

The top causes for all TT were Nontoxicity Related PD (25 pts, 44%), Hospice/Expired (12 pts, 26%), Nontoxicity related CD (5 pts, 8.8 %) and Disease Progression (5 pts, 8.8%).

For the 22 palliative intent patients, the top causes for TT were Hospice/Expired, and Nontoxicity Related PD (8 patients each, 36.4%). Reasons for the latter included unspecified patient choice, and desire to prioritize comfort over further treatment. For the 34 curative intent patients, the top causes for termination were Nontoxicity Related PD (17 pts, 50%), and Hospice/Expired (4 pts, 12%, all of whom died due to other comorbidities). Specific reasons for Nontoxicity related PD included refusal without a specific reason given (11 pts, 65%), change in location preference (4 pts, 24%), desire to focus on other comorbidities (2 pts, 12%), with roughly half (8/17 pts) receiving 0 fractions.

Conclusion: Radiation TTs reflect major deviations from the original care plan. Only 2.5% of GU cancer patients simulated in our department from 2013-2022 underwent premature termination of their course. We highlighted common causes here, with the most common being Nontoxicity related PD. Although specific reasons were not always clear, patient location preference and comorbidities were identified as factors which may merit discussion at time of consultation. Future studies can direct treatment decision-making and improve care for these patients.