Radiotherapy for Oncologic Emergencies on Weekends: Examining Reasons for Treatment and Patterns of Practice at a Canadian Cancer Centre

Abstract

PurposeRadiotherapy for oncologic emergencies is an important aspect of the management of cancer patients. These emergencies—which include malignant spinal cord compression, brain metastases, superior vena cava obstruction, and uncontrolled tumour hemorrhage —may require treatment outside of hospital hours, particularly on weekends and hospital holidays. To date, there remains no consensus among radiation oncologists regarding the indications and appropriateness of radiotherapy treatment on weekends, and treatment decisions remain largely subjective. The main aim of the present study was to document the incidence and indications for patients receiving emergency treatment on weekends or scheduled hospital holidays at a single institution. The secondary aim was to investigate the compliance of such treatment with the institution’s quality assurance policies, both local and provincial.MethodsFrom September 1, 2002, to September 30, 2004, patients being treated over weekends (defined as commencing at 6 pm on a Friday and concluding at 8 am of the next scheduled workday) and hospital holidays were retrospectively identified using the Oncology Patient Information System scheduling module. Relevant patient data—including patient age, sex, primary cancer site, specific radiation field, rationale for treatment, referring hospital, total treatment dose, radiation dose fractionation, inpatient or outpatient status, and duration of treatment—were collected and subsequently analyzed. Comparison to local policy was performed subjectively.ResultsOver the 2-year period, 161 patients were prescribed urgent radiotherapy over a weekend or on a hospital holiday. Of this cohort, 68% were treated on both Saturday and Sunday, 22% on Saturday alone, and 10% on Sunday alone. Most patients presented with lung (31%), prostate (18%), and breast cancer (17%). The top reasons for referral for emergency weekend treatment included spinal cord compression (56%), brain metastases (15%), and superior vena cava obstruction (6%). Most of the indications for treatment generally followed the quality assurance policies implemented both locally and provincially.ConclusionsPatients treated over a weekend or on a hospital holiday were generally found to be treated with appropriate intent. Most treatment indications within this study both complied with provincial policy and showed a pattern of care similar to that seen in other studies in the literature. Local policy appears to be robust; however, policy improvements may allow for more cohesiveness across radiation oncologists in patterns of care in this important group of patients. Comparisons with practice at other institutions would be valuable and also a key step in developing sound guidelines for all members of the radiotherapy community to follow.

Radiotherapy in oncological emergencies: fast-track treatment planning

“…These oncological emergencies are defined as "conditions arising from a reversible threat to an organ function, requiring radiation treatment within a few hours of diagnosis" [2]. In these cases, RT is indicated if no other measures are likely to have a similar rapid relief of symptoms [3].…”

Simulated consult and treatment exercise improves radiation oncology trainee confidence and knowledge

“…Malignant epidural spinal cord compression (MESCC) is the most common indication for an emergency referral to radiation oncology,[ 1 ] and it is therefore critical that radiation oncology residents quickly become facile with not only the clinical aspects of diagnosis and treatment but also with the practical and technical aspects of treatment delivery. In general, formal didactic instruction in radiation oncology is sparse prior to beginning focused residency training.…”

Acomprehensive computer database for medical physics on-call program

“…A medical physics on-call program is needed to support emergency radiotherapy for palliative cancer patients. [1][2][3][4][5] Although most emergency events are simple, single-or multiple-beam spinal cord or whole-brain irradiations, the availability of time and human resource are the key factors in the program. This is because the on-call physicist is requested to standby 24 hours, including both off and on working hours, and 7 days per week irrespective of weekends or public holidays.…”