ESTRO 2024 - Abstract Book

S1978

Clinical - Mixed sites, palliation

ESTRO 2024

2619

Digital Poster

90-day mortality after radical radiotherapy for lung and head and neck cancer in England

Daniela Tataru 1 , Alexander P Kao 1 , Alex Brokenshire 1 , Catherine Roe 1 , Katherine Thackray 1 , Katie Spencer 1,2,3

1 NHS England, National Disease Registration Service (NDRS), London, United Kingdom. 2 University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom. 3 Leeds Teaching Hospital NHS Trust, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

Purpose/Objective:

90-day mortality after radical radiotherapy has been recommended as a quality indicator for assessing the appropriate and safe delivery of radical/adjuvant radiotherapy. Whilst the risk of life-threatening side-effects is minimal in many indications (e.g., radiotherapy for breast or prostate cancer), in other settings these risks are increased, particularly when concurrent systemic anti-cancer therapy is delivered. Patients with lung cancer often suffer with other significant medical conditions which, either alone or in combination with cancer treatment, can lead to death within 90 days of the start of radical radiotherapy. Equally, patients with head and neck cancer are at risk of aspiration pneumonia and nutritional compromise, in addition to the risk of immuno-suppression due to concurrent chemotherapy. In both circumstances pre-treatment decision making must recognise these risks, whilst monitoring and support on treatment should mitigate the risk of adverse consequences. There is no ‘target’ 90 -day mortality rate following radical radiotherapy, indeed, aiming for a 90-day mortality of 0% would inevitably result in under treatment of individuals who might otherwise stand to benefit from treatment. As such, a useful estimate of the expected rate is the national average. In addition, presenting trust-level 90-day mortality rates provides an opportunity to review and improve clinical practice. The National Disease Registration Service (NDRS) (in partnership with The Radiotherapy Transformation Programme, NHS England) receives monthly submissions of standardised radiotherapy activity data and produces the Radiotherapy Data Set (RTDS). Data on radiotherapy activity taking place at English NHS Trusts between April 2018 and March 2022 were extracted from RTDS for all patients aged 18 and over. The analysis was based on all external beam radiotherapy episodes delivered for cancer treatment (ICD10 codes C33 - C34 for lung cancer and C00 - C14 or C30 - C32 for head and neck cancer) where the treatment intent recorded by the clinician was radical. Episodes were identified where the patient was reported to have died within 90 days, inclusive, of the start of the episode. The annual crude 90-day mortality rate (nationally and for each individual NHS Trust) was calculated as the percentage of patients who died within 90 days. Trusts with known data quality issues were excluded from the analysis. Funnel plots were used to visualise the 90-day mortality rates for the included NHS Trusts and identify those with 90-day mortality outside of the expected statistical variation. Material/Methods: