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The BC Cancer Agency Radiotherapy (RT) program started the Prospective Outcomes and Support Initiative (POSI) at all six centres to utilize patient-reported outcomes for immediate clinical care, quality improvement, and research. Patient-reported outcomes were collected at time of computed tomography simulation via tablet and 2 to 4 weeks post-RT via either tablet or over the phone by a registered nurse. From 2013 to 2016, patients were approached on 20,150 attempts by POSI for patients treated with RT for bone metastases (52%), brain metastases (11%), lung cancer (17%), gynecological cancer (16%), head and neck cancer (2%), and other pilots (2%). The accrual rate for all encounters was 85% (n = 17,101), with the accrual rate varying between the lowest and the highest accruing centre from 78% to 89% ( P < .001) and varying by tumour site ( P < .001). Using the POSI database, we have performed research and quality improvement initiatives that have changed practice.

Conclusion: This pilot study provides a unique mixed quantitative and qualitative understanding of the perceptions of patients with lung cancer and their CGs, and HCPs regarding DNR discussion. Our findings will help further the development of evidence-based guidelines and a broad prospective study that would have important implications for policies and practices around DNR discussions in order to reduce the emotional pain of dying patients, their CGs and HCPs.Purpose/Objective(s): There is abundant evidence and multiple guidelines in support of single fraction (SF) Radiation therapy (RT) for uncomplicated bone metastases (BoM), though a global reluctance to adopt this practice is prevalent. Multiple publications have recently reported on different jurisdictions' rate of SFRT use for BoM. However, it is difficult to interpret these results as the proportion of BoM that are complicated is unknown. We sought to determine the proportion of BoM that are complicated in a population-based RT program in order to act as a potential guide for assessing SFRT utilization rates. In addition, we sought to determine differences in prescribing practices by complicated versus uncomplicated BoM. Materials/Methods: All consecutive patients with BoM treated with RT in 2011 and 2013 were identified in a provincial Canadian cancer registry database. The precise definition of complicated BoM is still debated in literature, and BoM were classified as "complicated" if clinico-radiological features were suggestive of: confirmed fracture and neurological compromise (e.g. spinal cord compression), with or without associated soft tissue mass. Associations between choice of RT fractionation and BoM characterization whether "complicated or not" were confirmed through logistic regression. Results: A total of 6,651 RT courses prescribed to 3,782 patients, with median age of 66 years (range, 18-103 yrs). The most commonly treated skeletal site was spine (56.8%) followed by pelvis (18.2%). Most BoM arose from primary genitor-urinary (26.5%), lung (23.8%), and breast (21.9%) cancers. The incidence of complicated BoM was 32.1%, in decreasing order as a result of an associated soft tissue mass (18.3%), neurological compromise (18.7%), and pathological fracture (6.5%). The most common site of BoM with features of complication was extremity (43.6%), skull (42.7%), and spine (39.2%). Complicated BoM most commonly arose from primary hemato-lymphoid (39.1%), lung (34.2%), gastro-intestinal (32.5%), breast (28.4%), and genitor-urinary (28.4%) cancers. In our program SFRT was prescribed less commonly in complicated versus un-complicated BoM (38.1% vs. 61.4%; p < 0.001), which was confirmed on multivariable analysis (OR 0.40; 95% CI 0.36 e 0.45; p <0.0001). Conclusion: This study found that 32.1% of BoM are complicated by fracture, soft tissue mass, or neurological compromise (i.e. 67.9% were uncomplicated), and that they were less likely to receive SFRT. Given the abundant evidence for SFRT in the setting of un-complicated BoM, and the emerging evidence fo...

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