Timing of Urgent Inpatient Palliative Radiotherapy

Abstract: Purpose Urgent indications for palliative radiotherapy (RT) include malignant spinal cord compression, symptomatic brain metastases, pain, airway obstruction, and bleeding. Data on timing of palliative RT in the inpatient setting is limited. We report our experience with inpatient palliative RT at a tertiary academic center and evaluate the impact of a dedicated inpatient palliative RT nurse practitioner (NP) on treatment timelines. Methods We performed a retrospective single-institution review of 219 inpatients consulted for RT to sites of metastatic disease between 5/2012-5/2018. We compared time-to-treatment intervals before and after a palliative RT NP joined in 8/2017. Results The median age at RT was 61 (interquartile range (IQR) 51-69). The most frequent indications were symptomatic brain metastases (33%, 73/219), pain (28%, 61/219), and cord/cauda compression (22%, 48/219). The median time from consultation request to consult was 1 day (IQR 0-2) and from consultation request to first RT fraction was 3 days (IQR 2-6). Median time from consultation request to RT was shorter for cord compression (2 days, IQR 1-4) than pain (5 days, IQR 2-7) (p= 0.001) or symptomatic brain metastases (3 days, IQR 1-6 (p=0.037). With an NP, patients were more likely to undergo same-day consultation and simulation (75% vs. 60%, p=0.045), which was associated with shorter duration from consultation to initiation of RT (1 day (IQR 0-3 days) vs. 4 days (IQR 2-7 days), p Conclusion Time from consultation request to RT is necessarily short for urgent inpatient palliative RT. Advanced practice providers may facilitate and potentially expedite treatment, with significantly shorter times to treatment among patients who underwent same day consultation and simulation.