TY - JOUR
T1 - Caution is required in the implementation of 90-day mortality indicators for radiotherapy in a curative setting
T2 - A retrospective population-based analysis of over 16,000 episodes
AU - Spencer, K.
AU - Ellis, R.
AU - Birch, R.
AU - Dugdale, E.
AU - Turner, R.
AU - Sebag-Montefiore, D.
AU - Hall, G.
AU - Crellin, A.
AU - Morris, E.
N1 - Publisher Copyright:
© 2017 The Authors
PY - 2017/10
Y1 - 2017/10
N2 - Background: 90-day mortality (90 DM) has been proposed as a clinical indicator in radiotherapy delivered in a curative setting. No large scale assessment has been made. Its value in allowing robust comparisons between centres and facilitating service improvement is unknown. Methods: All radiotherapy treatments delivered in a curative setting over seven years were extracted from the local electronic health record and linked to cancer registry data. 90 DM rates were assessed and factors associated with this outcome were investigated using logistic regression. Cause of death was identified retrospectively further characterising the cause of 90 DM. Results: Overall 90 DM was 1.25%. Levels varied widely with diagnosis (0.20–5.45%). Age (OR 1.066, 1.043–1.073), year of treatment (OR 0.900, 0.841–0.969) and diagnosis were significantly associated with 90 DM on multi-variable logistic regression. Cause of death varied with diagnosis; 50.0% post-operative in rectal cancer, 40.4% treatment-related in head and neck cancer, 59.4% disease progression in lung cancer. Conclusion: Despite the drive to report centre level comparative outcomes, this study demonstrates that 90 DM cannot be adopted routinely as a clinical indicator due to significant population heterogeneity and low event rates. Further national investigation is needed to develop a meaningful robust indicator to deliver appropriate comparisons and drive improvements in care.
AB - Background: 90-day mortality (90 DM) has been proposed as a clinical indicator in radiotherapy delivered in a curative setting. No large scale assessment has been made. Its value in allowing robust comparisons between centres and facilitating service improvement is unknown. Methods: All radiotherapy treatments delivered in a curative setting over seven years were extracted from the local electronic health record and linked to cancer registry data. 90 DM rates were assessed and factors associated with this outcome were investigated using logistic regression. Cause of death was identified retrospectively further characterising the cause of 90 DM. Results: Overall 90 DM was 1.25%. Levels varied widely with diagnosis (0.20–5.45%). Age (OR 1.066, 1.043–1.073), year of treatment (OR 0.900, 0.841–0.969) and diagnosis were significantly associated with 90 DM on multi-variable logistic regression. Cause of death varied with diagnosis; 50.0% post-operative in rectal cancer, 40.4% treatment-related in head and neck cancer, 59.4% disease progression in lung cancer. Conclusion: Despite the drive to report centre level comparative outcomes, this study demonstrates that 90 DM cannot be adopted routinely as a clinical indicator due to significant population heterogeneity and low event rates. Further national investigation is needed to develop a meaningful robust indicator to deliver appropriate comparisons and drive improvements in care.
UR - http://www.scopus.com/inward/record.url?scp=85028030520&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028030520&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2017.07.031
DO - 10.1016/j.radonc.2017.07.031
M3 - Article
C2 - 28844331
AN - SCOPUS:85028030520
SN - 0167-8140
VL - 125
SP - 140
EP - 146
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 1
ER -