Palliative Radiation Oncology: A New Direction In Care

Health care costs have become an epidemic in the United States now representing a significant proportion of the GDP. Consequences are far-reaching, ranging from restricted wage growth to underfunded government programs. In efforts to improve efficiency and conserve resources, reimbursement structures are shifting from volume to value based metrics. New models of collaborative care are emerging. Specific challenges for radiation oncologists include the timing and delivery of costly treatments near the end of life, prognostic awareness, and complex care coordination. Here we demonstrate the impact of a dedicated inpatient palliative radiation oncology service at a large academic hospital. In 2015, a dedicated physician-resident-nurse practitioner team was established to oversee the care of approximately 350 inpatient consultations annually. The primary goal was to improve the timing, delivery, and appropriate use of palliative radiation near the end of life. In conjunction with morning rounds, participation in family meetings and daily consultations, radiation care plans were developed with the primary oncology and palliative care teams. This study compares inpatient care before (N = 225) and after (N = 225) the implementation of the dedicated consult service. In the first 10 months post inception, care coordination between the palliative care and radiation oncology teams increased from 15% to 60%. The utilization of short course radiation (≤5 fractions) increased from 30% to 70%. Goals of care documentation increased from 5% to 65%. The median length of stay for inpatient radiation patients decreased from 21 days to 9 days. The number of inpatient bed days decreased from 742 to 337. The number of patients that elected to receive radiation decreased from 90% to 63% Here, we demonstrate the impact of a dedicated inpatient palliative radiation service. Reductions in length of stay and number of inpatient bed days were observed. While fewer patients received palliative radiation, the total number of consultations increased- likely reflecting improved rapport and presence in the inpatient setting. Decreased utilization was felt to be secondary to better prognostic awareness and goals of care conversations. This program is well suited for quality-based care systems. It improves informed decision making and reduces near-end-of-life costs for patients. Short-course radiation aids pre-hospice treatments, timely discharge, and appropriate transitions of care. Potential benefits of this program to hospitals and clinicians are cost savings, better handling of complex care, improved patient, and provider satisfaction, and enhanced reputation amongst referring providers.