Abstract Book

S903

ESTRO 37

2.

To document the reasons for Loss to Follow-Up at each stage since the day of registration in the hospital.

better geographic distribution of such centres to avoid added burden to tertiary cancer hospitals may help in reducing the loss to follow-up. EP-1682 A single institution cross-sectional audit of outcomes in patients with brain metastases M. O'Cathail 1 , J. Weller 2 , J. Ho 1 , R. Clements 1 , J. Christian 1 , V. Crosby 2 , L. Aznar-Garcia 1 1 Notthingham University Hospitals NHS Trust, Oncology and Radiotherapy, Notthingham, United Kingdom 2 Notthingham University Hospitals NHS Trust, Palliative care, Notthingham, United Kingdom Purpose or Objective Up to 30% of patients with metastatic disease will develop brain metastases (BM). Patients are living longer due to advances in systemic anti-cancer therapy, however these are often ineffective at controlling BM. There is no consensus on management. Options include surgery, stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT) & steroids. In our region, the weekly neuro-oncology (NO) MDT discusses all intracranial tumours, lasts 2 hours and covers a population of 4 million. We assessed outcomes of patients with new diagnoses of BM and the current practice of our regional NO MDT as a basis for establishing a dedicated BM MDT. Material and Methods A cross-sectional audit of intracranial imaging was performed to identify new cases of BM within our trust over a one month period. These new cases’ records were accessed to look at their individual management and outcomes. A second audit of neuro-oncology MDT decisions from a 4 month period was performed to assess current practice. Results A total of 1,557 CT brain scans and 942 MRI head scans from a one month period (December 2013). Fifteen patients were identified as having a new diagnosis of BM with a further 15 having known BM. Of the new BM, 4 were discussed at the neuro-oncology MDT (1 biopsy, 1 shunt and 2 no treatment). Two patients were referred elsewhere for SRS, though these patients had not been discussed at the NO MDT. Only 8/15 had been prescribed steroids at diagnosis. Four patients died on the same admission as diagnosis and median survival of the group was 34 days (range 2-457 days). The 2 who received SRS were the longest survivors (335 & 457 days). Of the 11 patients who were discharged there was 18 admissions over the 1669 days of cumulative survival (1 admission per 92.7 days survival) including 6 admissions for one patient who received SRS (1 admission per 55.8 days). Decisions from 15 NO MDTs were accessed. There were 776 patient discussions meaning average patient discussion time was 2.3 minutes. Of these, 127 (16.4%) were about patients with BM. Their outcomes are listed below. MDT Outcome N=127 (%) Refer for SRS opinion 38 (29.9%) Surgery (incl. biopsy, shunt and resection) 11 (8.7%) No specific intervention recommended 42 (33.1%) Best supportive care 10 (7.9%) Rediscuss 10 (7.9%) WBRT 8 (6.3%) Post histology discussion 6 (4.7%) Imaging opinion given post SRS 2 (1.5%)

Material and Methods The departmental records of uterine cervical cancer patients who were registered in the Radiation Oncology out-patient department of our regional cancer centre between January 2016 and December 2016 were collected for this study. Data about socio-demographic variables, disease and treatment-related information were retrieved from the records. Patients who missed their due follow-up visit at each stage of their course of management were identified from the departmental follow-up register and contacted through phone for patients’ vital status and for determining the reasons for loss to follow-up Results The mean age was 53 ± 10 years. Thirty six percent of patients had Stage III & 23% had Stage II disease. Sixty four percent had been planned for radical radiation, 5% for adjuvant radiotherapy and 4% for palliative radiation. Among the 626 study participants, 372 (59.4%) had lost to follow-up at the time of the study at various stages of their management course since hospital registration. The distribution of patients who have lost to follow-up at various stages of the management is schematically depicted in the figure enclosed. The most common reason for loss to follow-up in our study was death while awaiting radiation treatment (33%) followed by long waiting period for radiotherapy (13%) while 5% could not continue their visits due to lack of chaperone support. Worsening clinical condition, long travel and feeling healthy were some minor reasons quoted. Around 2% had discontinued treatment and follow-up due to treatment related toxicities. Among 372 patients who had lost to follow-up, a sizeable number of patients (38%) could not be contacted over phone because of missing contact information. Patients who were planned for concurrent radiotherapy and chemotherapy were found to have significantly lesser risk in defaulting hopital visits than those who were planned for palliative treatments(<0.001). Age and stage of the disease were not found to be associated with loss to follow-up.

Conclusion Our study reveals that majority of cervical cancer patients registered in our regional cancer centre have been lost to follow up even before starting radiation treatment. So relevant measures to reduce the waiting period like increasing cancer treatment facilities and