GPP04 演讲时间：上午 9:27

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.006

Lauren M. Andring MD , Ramez Kouzy MDR , Kelsey L. Corrigan MD, MPH , Neil Bailard MD , Maliah Domingo BS , Bryan Fellman BS , Jasmine Varkey AGNP , Tomar Foster-Mills AGNP , Lilie Lin MD , Anuja Jhingran MD , Lauren Colbert MD , Ann H. Klopp MD, PhD , Melissa M. Joyner MD, MBA

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引用次数: 0

摘要

背景ERP是一种以患者为中心的标准化方案，旨在最大限度地减轻症状负担并促进术后功能恢复。ERP已被许多外科专科广泛采用，并显示出更好的疗效；然而，目前仍没有数据显示ERP对接受近距离放射治疗的患者的作用。方法在实施ERP前（33例）和实施ERP后（33例），对在一家机构接受确定性化疗（CRT）和近距离放射治疗的宫颈癌患者进行前瞻性试验。ERP包括初次就诊时转介营养和社会工作、术前碳水化合物负荷、围手术期预防性症状管理、目标导向输液、早期活动以及随访（FU）时转介盆底物理治疗。患者报告结果（PROs）使用 EORTC QLQ-C30 和 EORTC QLQ-CX24 有效调查指标进行评估，并在 CRT 前、治疗结束（EOT）和 60 天随访时收集。功能量表和总体健康状况的得分越高，表示疗效越好，而症状量表的得分越高，表示疗效越差。计算每位患者从 EOT 到 FU 的每个领域的得分差异，并分析每个队列的差异中位数，以评估术后功能恢复情况。10 分的差异被认为是显著的。采用 Wilcoxon 符号秩检验比较各组间住院时间的中位数，P<0.05 为显著。结果33 名患者加入了本研究的 ERP 前治疗组，其中 28 人（85%）完成了基线指标，22 人（67%）完成了 EOT 指标，21 人（64%）完成了随访 PRO 指标。另有 33 名患者参加了 ERP 后的研究，其中 28 人（85%）完成了基线问卷，25 人（76%）完成了 EOT，22 人（67%）完成了随访问卷。ERP后患者在FU时的健康相关生活质量（HRQOL）中位数明显更高（41.7 vs 25，P=0.001），与EOT相比，中位数提高了6.7分，而ERP前组群的中位数下降了-8.4分。从 EOT 到 FU，两组患者的症状负担均有总体下降，ERP 后的中位下降值为 -15.2pts，而ERP 前为 -6pts。放疗后组群的呼吸困难（-33分）和情绪功能（8.3分）在治疗后有明显改善，而放疗前组群的中位变化为0（图1）。从开始接受放射治疗到治疗后 60 天，ERP 前队列中未入院的急诊就诊总次数为 9 次，而ERP 后队列中为 13 次。结论对接受最终 CRT 和近距离放疗的宫颈癌患者实施标准化 ERP 可改善 HRQOL，减少入院次数，缩短住院时间，并改善多个症状领域的恢复情况。

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GPP04 Presentation Time: 9:27 AM

Background

An ERP is a standardized patient-centered protocol that aims to minimize symptom burden and enhance functional recovery after surgery. ERPs are widely adopted by many surgical specialties and have demonstrated improved outcomes; however, there remains no data looking at the role of an ERP for patients undergoing brachytherapy.

Methods

A prospective trial of cervical cancer patients treated at a single institution with definitive chemoradiation (CRT) and brachytherapy boost, before (n=33) and after (n=33) the implementation of an ERP. The ERP included referral to nutrition and social work at initial consult, pre-operative carbohydrate loading, peri-operative prophylactic symptom management, goal-directed fluid delivery, early mobility, and referral to pelvic floor physical therapy at follow-up (FU). Patient reported outcomes (PROs) were assessed using the EORTC QLQ-C30 and EORTC QLQ-CX24 validated survey metrics and were collected before CRT, at the end of treatment (EOT), and 60-day FU. Higher scores for functional scales and global health status represent favorable outcomes, while higher scores for symptom scales are unfavorable. The difference in individual patient score from EOT to FU was calculated for each domain and the median difference for each cohort was analyzed to evaluate post-procedure functional recovery. A difference of 10 points was considered significant. Wilcoxon signed rank test was used to compare median length of hospital stay between cohorts, p<0.05 was significant.

Results

Thirty-three patients were enrolled on the pre-ERP arm of this study, 28 (85%) completed baseline, 22 (67%) EOT, and 21 (64%) follow-up PRO metrics. An additional 33 patients were enrolled post-ERP, 28 (85%) completed baseline, 25 (76%) EOT, and 22 (67%) follow-up questionnaires. Median health related quality of life (HRQOL) at FU was significantly higher post-ERP (41.7 vs 25, p=0.001), with a median improvement from EOT of 6.7pts compared to a median decline of -8.4pts in the pre-ERP cohort. From EOT to FU both groups had an overall decrease in symptom burden, median decrease of -15.2pts post-ERP vs. -6pts pre-ERP. The post-ERP cohort reported significant improvement in dyspnea (-33pts) and emotional function (8.3pts) at FU, compared to median change of 0 in the pre-ERP cohort (Figure 1). From the start of radiation to 60 days FU, the total number of emergency room visits without admission was 9 in the pre-ERP cohort compared to 13 in the post-ERP cohort. However, the total number of hospital admissions was significantly higher in the pre-ERP cohort (17 vs 9) and the associated median length of hospital stay was significantly longer (3.9 vs 1.8 days, p =0.028).

Conclusion

A standardized ERP for cervical cancer patients undergoing definitive CRT and brachytherapy led to improved HRQOL, fewer hospital admissions, decreased hospital length of stay, and improved recovery in multiple symptom domains.

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.