Friday Start Date

[jb2]

Is there any data that patients who have their first treatment on a Friday have inferior outcomes to starting Mon-Thurs? My Attendings never wanted to start a patient on a Friday.

---

Members don't see this ad.

 

[Brim]

I'm not sure about that, but on a related note, here's an interesting paper:

http://www.ncbi.nlm.nih.gov/pubmed/11321668?dopt=Abstract
Always on a Friday? Time pattern of referral for spinal cord compression.
Poortmans P, Vulto A, Raaijmakers E.
Acta Oncol. 2001;40(1):88-91.

For patients with spinal cord compression, radiotherapy should be initiated as soon as possible to optimize the chances for restoration of neurological function. The speed of referral in the region of our radiotherapy institution with nine general hospitals was analysed based on a tumour and treatment-related registry. From January 1987 to December 1997, 443 patients were treated. All patients were seen and treated on the day of referral. Significantly more referrals took place on Friday, 30%, compared with 12% on Monday, 17% on Tuesday, 15% on Wednesday, 20% on Thursday, 5% on Saturday and 1% on Sunday (p < 0.002). This difference was the same for patients whether they were formerly treated in our institution (n = 242) or not (n = 201). No significant difference was found between different categories of patients (p = 0.28). These data are discussed with the referring physicians to encourage speed of diagnosis and referral.

PMID:
11321668

 

[medgator]

Is there any data that patients who have their first treatment on a Friday have inferior outcomes to starting Mon-Thurs? My Attendings never wanted to start a patient on a Friday.

It's because it's generally accepted practice to give a patient at least 2 fractions prior to a break. In that situation, it would require a therapist/physician to be there saturday. The only time that's done is an emergency situations, typically.

 

[deleted4401]

I almost never worry about it in defintive cases - i.e. I don't care what day we start, and I certainly don't make my therapist come on Saturday for it. It was heresy when I started, but now they know ... I tell them it's an old wives' tale.

Now, for a cord compression or a brain met, I could see the value of it, but again limited/no data. My partners and I (typically) give a big slug on Friday - 4 Gy or 5 Gy - and then start back on Monday with regular fractionation. If it is a long weekend with a Monday off (i.e. more than a 2 day gap between treatments), then we make the trek to treat on a Saturday. Thanksgiving is the biggest bummer, b/c 4 day off in a row (we stay open the Sunday before), so if there is a call, we end up having to treat 2 days. I think we've treated the last 3 years.

-Simul

 

[seper]

I never start a definitive course on Thu and Fri. There some old data on breast Ca showing that >= 3 tx per week are associated with superior outcome.

 

[Palex80]

For breast cancer patients, I tend to start with the boost upfront on a Thursday or Friday and then give 4 x 2.5 Gy rather than 5 x 2.0 Gy. After the boost is done, I continue with the tangents.

 

[ShirleyT]

i think it is old wives tale that you can't start patients on a friday. if i have a patient that wants to start on a friday to finish on a certain date due to scheduling, i have no problem and don't lose any sleep over it. at my former program, a very smart and wise attending actually coded local recurrences by xrt start date and did not find a difference but never actually published the results.

 

[seper]

Well, he should publish results.
Giving an epithelial tumor 72 hours to fix sublethal damage and translate repair genes is contra-intuitive.

 

[jb2]

So it appears that there is no data that starting on a Friday results in inferior outcome, only theory.

 

[TarHeelRadOnc]

So it appears that there is no data that starting on a Friday results in inferior outcome, only theory.

Exactly

 

[medgator]

So it appears that there is no data that starting on a Friday results in inferior outcome, only theory.

You could make the same argument about protons or Imrt. There are many areas in this fields where good randomized and even single arm data is lacking and we have to fall back to theory

 

[deleted4401]

You are telling me that with all the other variables involved, the first fraction on Friday (of 30 to 43 fractions for the most common 3 cancers we treat curatively) is something that affects local control? Over a population, perhaps one could possibly find an effect, even though (somewhat discredited) models of radiobiology indicate that those effects don't occur until after the third week. However, what about all the times people delayed treatment 3 days to start on a Monday? That can't help things either... It's a wash. Old habits die hard. It makes anxious patients (and me!) feel better to get things going rather than waiting until Monday for a theoretical benefit. If we really were worried, we'd start on any given day and stay open the following day (regardless of weekend or holiday) to avoid both ordinary tumor growth and repair issues. Something tells me it has less to do with radiobiology than "external" issues.

 

[medgator]

You are telling me that with all the other variables involved, the first fraction on Friday (of 30 to 43 fractions for the most common 3 cancers we treat curatively) is something that affects local control? Over a population, perhaps one could possibly find an effect, even though (somewhat discredited) models of radiobiology indicate that those effects don't occur until after the third week. However, what about all the times people delayed treatment 3 days to start on a Monday? That can't help things either... It's a wash. Old habits die hard. It makes anxious patients (and me!) feel better to get things going rather than waiting until Monday for a theoretical benefit. If we really were worried, we'd start on any given day and stay open the following day (regardless of weekend or holiday) to avoid both ordinary tumor growth and repair issues. Something tells me it has less to do with radiobiology than "external" issues.

I'm curious how people handle the 4 days off on Thanksgiving. a lot of places stay open that Friday, but some are closed for the whole four days, causing some to treat that Sunday before to give four fractions in a row

 

[deleted4401]

We open the Sunday before and then stay closed for 4 days ... There is no great way to handle it ... I guess you could stay open on Friday, but that's is incredibly difficult for patients and us. I wonder if you look at SEER data and see differences in outcomes in November ...

 

[seper]

Great idea, but SEER only codes months of the diagnosis. No info on RT start date. You'd have to get on hold of the Medicare-SEER linked database to get RT start dates, but those files are expensive.