ESTRO 36 Abstract Book

S751 ESTRO 36 _______________________________________________________________________________________________

EP-1406 Improvement in cancer pain management: the value of a joint approach in a single prospective series V. Masiello 1 , S. Mafrida 1 , F. Cellini 1 , F. Rodolà 2 , G. Cannelli 2 , S. Longo 1 , L. Polidori 2 , M. Balducci 1 , M. Rossi 2 , V. Valentini 1 1 Policlinico Universitario Agostino Gemelli- Catholic University, Department of Radiation Oncology – Gemelli- ART, Roma, Italy 2 Policlinico Universitario Agostino Gemelli- Catholic University, Department of Anesthesiology and Intensive Care Agostino Gemelli Hospital, Roma, Italy Purpose or Objective Pain management in cancer is a multifactorial challenge for clinicians. Multidisciplinary approach can improve survival and quality of life. In our center we applied a multidisciplinary integrated approach to pain management for outpatients. Purpose of this study was to detect a benefit in terms of quality of life with this approach. Material and Methods A team represented by radiation oncologist and anesthetist offered a weekly outpatient ambulatory. We enrolled patients (pts) with cancer pain from primitive tumor or metastases. Intervention included RT and/or drug modification/prescription after discussion of both clinicians. Timing of treatment administration was also case-by-case defined. For all the patients we collect performance status (PS), Numeric Rating Scale (NRS), Pain Management Index (PMI) value and Morphine Equivalent Dose (MED) at baseline and after a month of therapy. A complete pain response to radiotherapy was defined as: NRS 0 and no modification in baseline drugs. Results From November 2015 to April 2016 we evaluated 85 pts for a total of 122 sites of cancer pain referred. Of this pts, 10% came from consultations, 40% were send from care provider and 50% were on regular follow up. Twenty/85 pts (23.5%) presented cancer pain by primitive tumor. Sixty/85 pts (70.5%) presented bone metastases. At baseline: median PFS: 60% (30-80%); median NRS: 5 (3-10); median PMI: 0 (+1/-3). At first contact 31.8% pts had PMI between -1 and -3 (i.e.: pain not adequately controlled). Moreover, 13% of pts at the baseline didn’t assume any therapy and 31.7% assumed only FANS. Pts with a previous cancer pain therapy assumed a median MeQ of 150.5 mg (1-300 mg). All pts with bone metastases (60/85), underwent palliative RT for a total of 120 irradiated CTVs, as follows: 34/120 (%): 8 Gy/1 fx; 1/120 (%) 4 Gy x 2, 8/120 30 Gy/10 fr, 77/120 CTV with 20Gy/5fr. After 4 weeks, all the 85 baseline pts was visited/contacted. Median PFS was 60% (40-90), median NRS was 4.5 (0-9) ( Figure 1 ), median PMI was 2 (-1/3). At the first follow up only 2 pts presented a negative PMI (- 1) due to pain progression. Complete pain responders were 36%; 5.7% of pts continued to assume FANS only if required and the rest of pts presented a median MED of 150.5 mg (1-300 mg).

While WBRT does have a role in treating some patients with brain metastases, as shown by the long survival of some patients, they should be carefully selected, particularly when considering treating elderly patients. EP-1405 A Rapid Access Palliative Radiotherapy Clinic to reduce waiting time in a Regional Cancer Centre M. Morris 1 , T. O'Donovan 1 , B. Ofi 1 , A. Flavin 1 1 Cork University Hospital, Radiation Oncology, Cork, Ireland Purpose or Objective In September 2014, the Rapid Access Palliative Clinic [RAPC] was set up in the Radiation Oncology Department in Cork University Hospital [CUH] a Regional Cancer Centre in Ireland. Its purpose is to streamline the pathway and facilitate prompt review and timely delivery of palliative radiotherapy [PRT] for symptom relief of patients with terminal cancer. This study reviews the clinical activity of the RAPC over the initial 3 months and compares it to a second 3 months where the clinic was not available. The purpose of this retrospective review is to evaluate if we are meeting the objectives of the RAPC program. Material and Methods From the CUH oncology patient information system (Lantis) database, we retrieved the number of patients referred to the RAPC, their demographics, diagnosis and treatment. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of patients who started PRT on the day of their initial RAPC consultation. We calculated the 30-day mortality of patients who received treatment. We then compared the data from the initial 3 months when the clinic was active from 1 st September to 30 th November 2014 against a 3 month period from 1 st May to 31 st July, 2016 inclusive, when there was no clinic due to staffing shortages. Results During the initial 3 month period where the RAPC was active, the number of cases seen in consultation was 129. Patient’s ages ranged from 28.4 to 96 years with a mean age of 69.1 years. Most common primary tumour sites were Genitourinary and Lung accounting for 25% and 21% of the patient population. Most common indication for PRT was bone pain accounting for 69% of patients seen in the clinic. Of the 122 patients who received PRT, 57 patients (46.7%) received single fraction PRT whilst 65 patients (53.2%) received fractionated PRT. 98% were seen within 2 weeks of referral (87% within 1 week). The 30-day mortality rate was 13.95%. When comparing the 2 periods the overall median interval from referral to consultation was 3.9 days with RAPC vs 3.7 days with no RAPC. The median time from consultation to simulation was 0.9 days with RAPC vs 2.7 days with no RAPC. 74% were simulated on the day of their initial consultation with RAPC vs 31.4% with no RAPC. 35% started their PRT treatment on the day of their consultation visit with RAPC vs 23% with no RAPC. Conclusion The comparison between the initial 3 months of the RAPC vs the 3 months with no RAPC showed the median time from consultation to simulation tripled, the percentage of patients who were simulated on the day of consultation fell by half and only 23% received same day treatment. The 30-day mortality rate is consistent with UK studies and suggests appropriate patient selection. Running a dedicated palliative clinic decreased waiting times, reduced the number of visits to the Regional Cancer Centre and provided prompt PRT to symptomatic patients in the terminal phase of their illness. The RAPC is therefore meeting our objectives.