174: Patient-Family Feedback on Consultation for New Diagnosis of Brain Metastases: Value of Team Approach to Care
Bibliographic record
Abstract
Purpose: To describe the case mix, intervention efficacy and prognosis of patients with advanced lung cancer attending a Fast Track Lung (FTL) clinic that was established to improve timeliness of access to palliative RT.Methods and Materials: Pre-treatment and treatment information was prospectively collected on FTL patients seen from January 2014 to December 2015.Palliative RT use was decided based on clinical/radiologic information suggesting that one or more specific symptoms were reasonably likely to be helped.Phone follow up by a nurse 1-2 months later assessed the effect of RT on each index symptom.Results: Two hundred and fourteen patients were assessed a total of 310 times, a mean of 1.5 times per patient (range 1-8).Eighty-six percent had non-small cell histologies (71% adenocarcinoma, 22% squamous cell carcinoma).Most were ECOG 2 (30%) or 3 (46%) at the time of first presentation.Median survival from initial FTL consult was 3.2 months (95% CI 2.2 -3.6) for the entire group; for ECOG 0 -1, it was 12.3 months (95% CI 7.4 -16.2) and for ECOG 3 -4, 1.8 months (95% CI 1.5 -2.2).EGFR mutation positive patients had a median survival of 12.5 months (95% CI 4.3 -39.8).224 of the 310 clinic visits resulted in palliative RT to at least one site, of which 161 (72%) had phone follow up.Three hundred and ninety courses of RT were delivered, a mean of 1.8 per patient, (range 0 -13).Forty-nine percent of RT courses were delivered to bony sites other than ribs, 22% to the chest, 14% to the chest wall/ribs and 10% to the brain.Thirty-once percent were single fractions and 92% were < 5 fractions.Median dose was 20 Gy and the median number of fractions was 5.Among patients receiving RT to one or more concurrent site(s), 80% reported some benefit.Seventy-seven percent of patients receiving RT to the chest reported improvement in at least one index symptom.This varied by symptom (e.g.dysphagia 33%, cough 82%, hemoptysis 100%).Eighty percent of treated bone mets became less painful.If one assumes that every patient without follow up information had no benefit, still 59% were helped.Conclusions: Palliative RT, generally with 5 or fewer fractions, helped most patients with clinically or radiologically targetable symptoms who attended a dedicated Fast Track Lung clinic.Phone follow up is a feasible way to obtain patient or family reported outcome information.Median survival was short, although considerably longer in patients with good performance status and/or an EGFR mutation, in whom the potential benefits of more intensified palliative RT should be investigated.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.060 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.023 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".