Inpatient Radiation Oncology Consult Model for Metastatic Cancer to Reduce Hospital Length of Stay

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In a single-institution study reported in JCO Oncology Practice, Xu et al found that implementation of a novel inpatient radiation oncology consult service was associated with a significant increase in consults involving metastatic disease specialists, as well as a reduction in hospital length of stay among patients that was greatest among those who received radiation therapy.

As stated by the investigators, “Palliative care and radiation therapy have played an expanding role in the management of patients with advanced cancers. Recent advances in our understanding of oligometastatic disease have led to increasing demand for familiarity with ablative techniques. Recognizing the demands of hospitalized patients for rapid access to care, we created an inpatient radiation oncology consult service with consolidated expertise in palliative radiation and ablative techniques.”

Study Details

The quality improvement cohort study involved analysis of inpatient radiation oncology consults placed before and after implementation at Memorial Sloan Kettering Cancer covering the periods from January to June 2019 and January to June 2020.

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The inpatient radiation oncology consult service team consisted of radiation oncology faculty, advanced practice providers, nurses, and an administrative assistant. Faculty involvement was aligned with specializations in treating metastatic patients, including certification in hypofractionated and ablative radiation techniques.

The inpatient radiation oncology consult service staff was notified of placement of a consult to radiation oncology on an urgent basis for each patient. Cases were presented in multidisciplinary tumor boards focused on spine, brain, and bone metastases. Plans were reviewed in biweekly chart rounds by radiation oncologists with expertise in metastatic disease.

Key Findings

A total of 603 inpatient consultations were placed during the pre–consult team period, compared with 649 consults in the post–consult team period. Implementation of inpatient radiation oncology consult service was associated with increased delivery of specialty care, with the proportion of consults evaluated by a metastatic disease specialist increasing to 97% (628 of 649) from 23% (139 of603) during the pre­–consult team period. Compared with the pre–consult team period, consults placed to the inpatient radiation oncology consult service were staffed earlier by attending physicians by 0.95 days (P = .0001).

Among all inpatient consults, the median hospital length of stay was reduced from a median of 8 days (interquartile range [IQR] = 4–16 days) in the pre–consult team period to a median of 7 days (IQR = 3–13 days) during the post–consult team period (P =.005). Among 218 pre­–consult team vs 208 post­–consult team patients who received inpatient radiation therapy, median hospital stay was 14.5 days (IQR = 7–25 days) vs 11 days (IQR = 6–19 days; P = .007).

Among 115 vs 139 patients who received outpatient radiation therapy, median length of stay was 5.0 vs 5.0 days. Among 270 vs 302 patients who received no treatment, median stay was 6.0 vs 6.0 days.

The investigators concluded, “Our institutional experience demonstrates the value of recognizing metastatic disease as a distinct discipline and providing rapid access to palliative treatments for patients with advanced malignancies. Our experience demonstrates that radiation therapy for patients with metastatic disease requires investment in program building and institutional support. The role of radiation in patients with metastatic disease continues to grow, and rapid access with inpatient radiation oncology teams is important for delivering high-quality care.”

Amy J. Xu, MD, PhD, of Memorial Sloan Kettering Cancer Center, is the corresponding author for the JCO Oncology Practice article.

Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit

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