Treatment Terminations During Radiation Therapy: A 10-Year Experience

Area of Science:

• Oncology
• Radiation Oncology
• Healthcare Quality Improvement

Background:

• Radiation therapy is a cornerstone of cancer treatment.
• Patients may terminate radiation therapy prematurely for various reasons.
• The incidence and trends of treatment termination (TT) in radiation oncology are not well-documented.

Purpose of the Study:

• To determine the incidence of treatment termination (TT) in a large, multicenter radiation oncology department over a 10-year period.
• To analyze trends in TT rates and identify common causes and disease sites associated with premature treatment discontinuation.

Main Methods:

• Prospective analysis of TTs from January 2013 to January 2023 as part of a quality and safety program.
• TT defined as premature discontinuation after initiating radiation planning.
• Root cause analysis of all TT cases presented at monthly morbidity and mortality conferences.

Main Results:

• A total of 1448 TTs occurred, representing 4.6% of 31,199 planned radiation courses.
• The TT rate decreased from 8.49% in 2013 to 3.02% in 2022.
• Common reasons for TT included hospice/expiration (35.9%), patient choice (35.2%), and clinician choice (11.5%), with central nervous system and head/neck cancers being most affected.

Conclusions:

• A significant year-over-year decrease in TT rates was observed.
• Quality improvement initiatives, including root cause reviews and monthly case discussions, likely contributed to the reduction in TTs.
• Understanding and addressing the causes of TT can help minimize preventable treatment discontinuations.