GPP06 Presentation Time: 8:50 AM

Purpose

ERPs have been adopted by many surgical specialties and have demonstrated improved outcomes, including shorter hospital stay, decreased healthcare costs, improved time to functional recovery and patient satisfaction.¹ There is no current literature evaluating ERP for patients undergoing brachytherapy as part of their radiation treatment. We plan to implement an ERP to standardize and optimize the peri-operative phase and to determine the impact on patient outcomes.

Methods

A single institution, prospective study evaluating the outcomes of patients undergoing GYN-BT before (33 patients) and after (33 patients) the implementation of an ERP. The ERP will include multidisciplinary interventions that span the pre-, intra-, and post-operative phases; including pre-habilitation, early referral to social work and psychiatric services, patient/caregiver education, pre-operative carbohydrate-loading, goal directed fluids, and opioid-sparing analgesia. Questionnaires (MDASI-PeriOp-GYN, EORTC QLQ-C30, and EORTC QLQ-CX24) to assess patient reported outcomes (PROs) at baseline, post-brachytherapy, and 60-day follow-up are collected. MDASI-PeriOp-GYN consists of 28 questions, scored from 0 to 10, with a score ≥7, considered severe.

Results

Twenty patients have enrolled and completed baseline PROs, of these 7 have completed post-brachytherapy surveys. Baseline mean total score was 3.07 (range, 1.3-7.9) and post-BT was 2.78 (range, 0.1-5.5). Mean number of severe events at baseline was 7 vs. 5.7 after brachytherapy. Independent symptom scores for the baseline population were worse for distress (3.7 vs 3), sadness (3.9 vs 2.4), ability to work (4.9 vs 4.4), relations with others (2.7 vs 2.1), pain (2.6 vs 2.0), constipation (3.1 vs 2.0) and bloating (3.1 vs 1.9); while post-BT scores were worse for dysuria (1.4 vs 0), diarrhea (4.6 vs 4.1), vomiting (1.4 vs 1.1), dizziness (2.1 vs 1.4), fatigue (6.1 vs 5.6), and hot flashes (2.9 vs 1.7) (Figure 1).

Conclusion

Female patients with gynecologic malignancies represent a population with high-symptom burden and social stress throughout treatment. Baseline data show that patient experience may be improved through early focus on social support and pain control and optimization of symptom management after brachytherapy; including nausea/vomiting, diarrhea, dehydration, and urinary toxicity. Our proposed ERP plans to address both of these initiatives.