Innovative Model Improves Care for Patients With Bone Mets

Roxanne Nelson, RN, BSN

October 09, 2015

An innovative model that combines palliative care with radiation oncology leads to better results for patients with painful bone metastases than was previously seen with standard care within the same unit.

The model was established at Mount Sinai Medical Center, in New York City. Since its implementation in 2013, the service has led to shorter durations of radiation treatment, fewer unfinished radiation treatments, shorter hospital stays, and increased use of palliative care services.

The standard treatment for bone metastases is 10 radiation treatments. "However, randomized, phase 3 trials have shown that one fraction of radiation can be just as efficacious as 10 fractions, but shorter courses of treatment are underutilized by radiation oncologists today," said senior author Kavita Dharmarajan, MD, an assistant professor of radiation oncology and palliative medicine at Mount Sinai Medical Center.

Dr Dharmarajan was speaking at a press briefing held in advance of the upcoming Palliative Care in Oncology Symposium (PCOS) 2015.

"What we proposed was a model that combined the core principles of palliative care with technical and procedural principles of radiation oncology in a service model that prioritizes the whole- patient approach and management plan," she explained.

To compare outcomes of a newly established palliative radiation oncology service with those of standard care, Dr Dharmarajan and her colleagues conducted an analysis of 336 patients with stage IV or incurable cancer who received radiation therapy for bone metastases.

From December 2010 to September 2013, 175 patients received standard care; from December 2013 to September 2015, 161 patients received care from a palliative radiation oncology service.

The new service model is available to all patients with any type of cancer who are receiving radiation for palliative purposes, whether it be for metastases in the bone, brain, lung, pelvis, or any other organ system in the body. The current study focused only on patients with bone metastases.

Five Main Findings

"We found five main results in our study," said Dr Dharmarajan. "The first was that the duration of treatment declined."

Before implementation of the service, 74% of patients received more than five fractions of radiation. That number declined to 39%. Conversely, the new service more than doubled the use of single-fraction radiotherapy, and short-course radiotherapy increased from 26% to 61% (P = .001)

A shorter course of treatment had a direct impact on length of hospital stay. "Some patients who are too debilitated to go back and forth had to stay in the hospital for the duration of their treatment," she explained. "Increasing the use of short-course radiation treatments is associated with reduced time spent in the hospital for patients and families."

The median length of stay decreased from 18 days to 12 days (P = .01).

There were also improvements in patient outcomes. More patients were completing their treatment after the new model was introduced (92% vs 85%; P = .04), and there were similar rates of pain relief within 1 month of completing treatment (80% vs 74%; P = .18). "It was a little better, although it was not significant," said Dr Dharmarajan.

Finally, a larger percentage of patients in the new model received palliative care services after completing radiation treatment (49% vs 34%; P = .003).

"This study shows firsthand the impact of incorporating radiation with palliative care treatment,” commented Don S. Dizon, MD, clinical codirector of gynecologic oncology, Massachusetts General Hospital, and press cast moderator and ASCO expert.

"It shows that it's not only possible to tailor our treatment for patients, leading to better utilization of resources and higher completions of therapy, but we can do so without negatively impacting the goals of treatment in the first place," he added.

The authors have disclosed no relevant financial relationships.

Palliative Care in Oncology Symposium (PCOS) 2015: Abstract 110. Presented October 9, 2015.


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