ESTRO 37 Abstract book

S890

ESTRO 37

professionals lack the basic knowledge and harbor misconceptions about the clinical use of morphine for cancer pain treatment. Creating training opportunities for medical staff is necessary to increase their awareness and knowledge of effective cancer pain management. EP-1651 Radiation oncologists’ role in end-of-life care: a view from medical oncologists T. Kruser 1 , J.M. Kruser 2 , J.P. Gross 1 , M.R. Moran 2 , K. Kaiser 3 , E. Szmuilowicz 4 , S.M. Kircher 2 1 Northwestern Memorial Hospital, Radiation Oncology, Chicago IL, USA 2 Northwestern Memorial Hospital, Medicine, Chicago IL, USA 3 Northwestern Memorial Hospital, Medical Social Sciences, Chicago IL, USA 4 Northwestern Memorial Hospital, Medicine- Section of Palliative Medicine, Chicago IL, USA Purpose or Objective Radiation oncologists report a fear of upsetting medical oncologists as a key barrier to their involvement in end- of-life care planning with patients with advanced cancer. We sought to characterize medical oncologists’ perspectives on the role for radiation oncologists in end- Four professionally-moderated focus groups were conducted. A national sample of medical oncologists (N=31) was recruited using snowball sampling. Audio recordings of each focus group were transcribed verbatim. Four investigators from diverse healthcare backgrounds (medical oncology, radiation oncology, critical care medicine, public health) independently reviewed each transcript, coding sections of transcribed text to generate concepts and themes. Consensus coding was performed during meetings of at least three investigators, and the codebook was revised and applied to subsequent transcripts in an iterative process. Results Medical oncologists expressed complex and often conflicting views on the role of radiation oncologists in end-of-life care (Table 1). Radiation oncologists were compared to surgeons, as physicians who provide a finite intervention and lack longitudinal patient contact. In this context, medical oncologists perceived the radiation oncology culture as not engaged in providing end-of-life care. Medical oncologists described 'owning” the patients, and not wanting radiation oncologists to expand their scope of practice towards discussing end-of-life care planning with patients. Medical oncologists expressed concerns about the capability of radiation oncologists to accurately prognosticate and mistrust of radiation oncologists’ knowledge about available systemic therapy options. While communication from radiation oncologists towards medical oncologists regarding patient trajectory was reported as valuable, medical oncologists were frequently not open to giving radiation oncologists autonomy in providing an independent assessment of end- of-life care options. A proposed model of integrated palliative care consultation at the time of palliative radiation was met with skepticism given concern over the lack of medical oncology input into involvement of this additional service. Radiation oncologists’ fear of upsetting medical oncologists was felt to be justified if radiation oncologists discussed end-of-life planning without prior communication or alignment with the medical oncologists’ end-of-life care plan. of-life care planning. Material and Methods

Conclusion Participation of radiation oncologists in end-of-life care planning was viewed with skepticism by medical oncologists. Radiation oncologists who endeavor to routinely incorporate end-of-life care planning in their practice should focus on open communication with medical oncologists and developing trust around their ability to prognosticate and counsel patients regarding end-of-life options. EP-1652 Moderately hypofractionated radiotherapy for unresectable esophagus-gastric carcinoma. F. Lopez-Campos 1 , E. Carrasco 1 , C. De la Pinta 1 , M. Martín-Martín 1 , M. Martín-Sanchez 1 , J. Domínguez 1 , A. Hervás 1 1 Hospital Ramon y Cajal, Oncología Radioterápica, Madrid, Spain Purpose or Objective A moderately hypofractionated radiotherapy schedule for unresectable esophagus-gastric carcinoma was prospectively evaluated in terms of efficacy, palliation of cancer-related symptoms and acute toxicities. Material and Methods Patients with clinically unresectable tumours of the esophagogastric junction or gastric adenocarcinoma who were not candidates for treatment with chemotherapy were enrolled in this study. The radiation dose was 37,5Gy/15 fractions administered with a three- dimensional conformal radiation technique. The primary endpoint was palliation of cancer-related symptoms. Secondary endpoints included local control and toxicity. Palliation of cancer-related symptoms and toxicity were prospectively evaluated according to CTCAEv4 criteria. Results From July 2015 to October 2017, 19 patients were treated by the reported schedule. Median age was 85 (63- 89). Stage of cancer were: 38% stage IIB, 15% stage IIIA. 15% stage IIIB and 32% stage IIIC. All patients were able to complete the entire hypofractionated radiotherapy schedule. Median follow up was 6 months (1-18), local control was 86% and palliation of cancer-related symptoms was 100%. 5 patients (26%) had grade I acute gastrointestinal toxicity and 4 patients (21%) grade II. No toxicities Grade ≥ 3 were described.