title: 30 day mortality in adult palliative radiotherapy--A retrospective population based study of 14,972 treatment episodes.
abstract: BACKGROUND
  30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator.
  
  
  METHODS
  All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression.
  
  
  RESULTS
  14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1day (IQR 1-7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p<0.01).
  
  
  CONCLUSIONS
  This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems.
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom. Electronic address: katie.spencer1@nhs.net.
authors: Katie
authors: K
authors: Spencer
authors: Cancer Epidemiology Group, Section of Epidemiology and Biostatistics, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom.
authors: Eva
authors: E
authors: Morris
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom.
authors: Emma
authors: E
authors: Dugdale
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom.
authors: Alexander
authors: A
authors: Newsham
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom.
authors: David
authors: D
authors: Sebag-Montefiore
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom.
authors: Rob
authors: R
authors: Turner
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom; Section of Clinical Oncology, Institute of Cancer and Pathology, University of Leeds, St James's University Teaching Hospital, United Kingdom.
authors: Geoff
authors: G
authors: Hall
authors: St James's Institute of Oncology, Leeds Cancer Centre, St James's University Teaching Hospital, United Kingdom.
authors: Adrian
authors: A
authors: Crellin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D010166:Palliative Care; D012189:Retrospective Studies; D013222:State Medicine; D013997:Time Factors
keywords: 30day mortality; Clinical indicator; Fractionation; Palliative radiotherapy