Letter / Clinical Oncology 26 (2014) 804e807
807
The Assessment of Deaths after Radiotherapy is an Essential Part of Service Evaluation d Results of a 30 Day Mortality Audit of Patient Deaths after Palliative Radiotherapy Sir d Silverman et al. [1] recommended the wider publication of local 30 day mortality figures after palliative chemotherapy. We have expanded upon these recommendations and have audited deaths within 30 days after radiotherapy. Deaths of patients who died within 30 days of radiotherapy treatment between September 2012 and February 2013 were audited. Forty-seven of 1483 patients had died within 30 days of starting radiotherapy. The mean age of patients who died was 66 years (range ¼ 22e84). Sixty-two per cent of these were male and 38% were female. The patients who died were diagnosed with 13 different primary cancers, the most common being lung cancer (39%), prostate cancer (15%) and upper gastrointestinal malignancies (10%). Patients received treatments to many sites, predominantly secondary brain metastases (34%) and the spine (28%). Ninety-eight per cent of patients (n ¼ 46) were treated with palliative intent. The overall 30 day mortality rate after palliative radiotherapy was 11.6%. Twelve per cent of patients did not complete the planned radiotherapy due to clinical deterioration suggestive of disease progression. No evidence could be identified of toxicity contributing to death. Only one patient died within 30 days of receiving radical radiotherapy. This was an 83-year-old man diagnosed with a limited stage small cell lung cancer who received radical radiotherapy (40 Gy in 15 fractions) to the left lung after an excellent clinical response to chemotherapy. Unfortunately, 10 days after finishing treatment he was admitted as an emergency after a collapse at home. He had neurological symptoms suggestive of a Cerebrovascular accident (CVA), but a computed tomography brain scan did not show any acute changes and importantly did not show any evidence of cerebral metastases. His neurological condition deteriorated and he developed sepsis from presumed aspiration pneumonia. He died 15 days after completing radiotherapy. Only a handful of UK centres have published their 30 day radiotherapy mortality figures. Our mortality rate is in keeping with the results of other series [2e5]. It is
important that all services benchmark their outcomes against other centres. Although, as may be expected, there was no clear evidence of toxicity contributing to patient deaths, it is vital that there is careful patient selection for palliative radiotherapy taking into account the potential for side-effects versus likelihood of benefit. This is of particular importance for patients within the last few months of life, given the need for daily hospital visits. A regular audit will probably have a number of benefits, including improved understanding of prognostic indicators and patient outcomes after palliative radiotherapy and an increase in evidence-based practice. A. Boardman*y, H. Clements*, D. Kellett*, C. Mitchell*, R. Board* * Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green North, Preston, Lancashire, UK y
University of Manchester, Oxford Road, Manchester, UK
References [1] Silverman R, Smith L, Sundar S. Benchmarking 30 day mortality after palliative chemotherapy for solid tumours. Clin Oncol 2014;26(4):236. [2] Spencer K, Dugdale E, Hall G, Sebag-Montefiore D, Crellin A. A validation of 30 day mortality as a national palliative radiotherapy outcome measure. Leeds: Leeds Teaching Hospitals NHS Trust. Available at: http://conference.ncri.org.uk/ abstracts/2012/abstracts/LB135.html [accessed 26 June 2014]. [3] Gripp S, Mjartan S, Boelke E, Willers R . Palliative radiotherapy tailored to life expectancy in end stage cancer patients: reality or myth. Cancer 2010;116(13):3251e3256. [4] Treece SJ, Jephcott CR. Mortality following palliative radiotherapy- are we over using fractionated treatments? Cambridge: Department of Clinical Oncology, Addenbrookes Hospital. Available at: http://www.rcr.ac.uk/docs/oncology/ pdf/Posteraudit_Treece_SJ_2012.pdf [accessed 26 June 2014]. [5] Osborne GEC, Spendley DG, Nikapota AD. An audit of 30 and 90 day mortality after 382 courses of external beam radiotherapy in unselected patients. Brighton: Sussex Cancer Centre, Royal Sussex County Hospital. Available at: www.ncin.org.uk/view? rid¼2285 [accessed 26 June 2014].
http://dx.doi.org/10.1016/j.clon.2014.09.005 Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved
807
The Assessment of Deaths after Radiotherapy is an Essential Part of Service Evaluation d Results of a 30 Day Mortality Audit of Patient Deaths after Palliative Radiotherapy Sir d Silverman et al. [1] recommended the wider publication of local 30 day mortality figures after palliative chemotherapy. We have expanded upon these recommendations and have audited deaths within 30 days after radiotherapy. Deaths of patients who died within 30 days of radiotherapy treatment between September 2012 and February 2013 were audited. Forty-seven of 1483 patients had died within 30 days of starting radiotherapy. The mean age of patients who died was 66 years (range ¼ 22e84). Sixty-two per cent of these were male and 38% were female. The patients who died were diagnosed with 13 different primary cancers, the most common being lung cancer (39%), prostate cancer (15%) and upper gastrointestinal malignancies (10%). Patients received treatments to many sites, predominantly secondary brain metastases (34%) and the spine (28%). Ninety-eight per cent of patients (n ¼ 46) were treated with palliative intent. The overall 30 day mortality rate after palliative radiotherapy was 11.6%. Twelve per cent of patients did not complete the planned radiotherapy due to clinical deterioration suggestive of disease progression. No evidence could be identified of toxicity contributing to death. Only one patient died within 30 days of receiving radical radiotherapy. This was an 83-year-old man diagnosed with a limited stage small cell lung cancer who received radical radiotherapy (40 Gy in 15 fractions) to the left lung after an excellent clinical response to chemotherapy. Unfortunately, 10 days after finishing treatment he was admitted as an emergency after a collapse at home. He had neurological symptoms suggestive of a Cerebrovascular accident (CVA), but a computed tomography brain scan did not show any acute changes and importantly did not show any evidence of cerebral metastases. His neurological condition deteriorated and he developed sepsis from presumed aspiration pneumonia. He died 15 days after completing radiotherapy. Only a handful of UK centres have published their 30 day radiotherapy mortality figures. Our mortality rate is in keeping with the results of other series [2e5]. It is
important that all services benchmark their outcomes against other centres. Although, as may be expected, there was no clear evidence of toxicity contributing to patient deaths, it is vital that there is careful patient selection for palliative radiotherapy taking into account the potential for side-effects versus likelihood of benefit. This is of particular importance for patients within the last few months of life, given the need for daily hospital visits. A regular audit will probably have a number of benefits, including improved understanding of prognostic indicators and patient outcomes after palliative radiotherapy and an increase in evidence-based practice. A. Boardman*y, H. Clements*, D. Kellett*, C. Mitchell*, R. Board* * Lancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Sharoe Green North, Preston, Lancashire, UK y
University of Manchester, Oxford Road, Manchester, UK
References [1] Silverman R, Smith L, Sundar S. Benchmarking 30 day mortality after palliative chemotherapy for solid tumours. Clin Oncol 2014;26(4):236. [2] Spencer K, Dugdale E, Hall G, Sebag-Montefiore D, Crellin A. A validation of 30 day mortality as a national palliative radiotherapy outcome measure. Leeds: Leeds Teaching Hospitals NHS Trust. Available at: http://conference.ncri.org.uk/ abstracts/2012/abstracts/LB135.html [accessed 26 June 2014]. [3] Gripp S, Mjartan S, Boelke E, Willers R . Palliative radiotherapy tailored to life expectancy in end stage cancer patients: reality or myth. Cancer 2010;116(13):3251e3256. [4] Treece SJ, Jephcott CR. Mortality following palliative radiotherapy- are we over using fractionated treatments? Cambridge: Department of Clinical Oncology, Addenbrookes Hospital. Available at: http://www.rcr.ac.uk/docs/oncology/ pdf/Posteraudit_Treece_SJ_2012.pdf [accessed 26 June 2014]. [5] Osborne GEC, Spendley DG, Nikapota AD. An audit of 30 and 90 day mortality after 382 courses of external beam radiotherapy in unselected patients. Brighton: Sussex Cancer Centre, Royal Sussex County Hospital. Available at: www.ncin.org.uk/view? rid¼2285 [accessed 26 June 2014].
http://dx.doi.org/10.1016/j.clon.2014.09.005 Ó 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved
