Unassessed Response After Palliative Radiotherapy: A Retrospective Study of Evaluable but Not Evaluated (EBNE) Episodes.

Abstract

Palliative radiotherapy (RT) is widely used for symptom control across diverse clinical settings. In routine practice, however, post-treatment evaluation may not be consistently documented. We examined real-world patterns of response documentation after palliative RT and identified episodes that were clinically evaluable but not formally evaluated. We retrospectively reviewed 309 treatment episodes of palliative RT delivered between September 2018 and March 2019. Clinical records were examined to determine whether radiation oncologist-authored documentation was present within 16 weeks after RT. Follow-up duration was compared between radiation oncologists and non-radiation oncology providers. Episodes were classified as evaluated, non-evaluable (death or loss to follow-up within 60 days), or evaluable but not evaluated (EBNE; survival beyond 60 days with continued institutional follow-up but no radiation oncologist-authored documentation within 16 weeks). Among 309 treatment episodes (median age, 64.5 years), radiation oncologist-authored documentation was observed in 199 episodes (64.4%). Follow-up duration ranged from 0 to 413 days (median, 75 days) for radiation oncologists and from 0 to 418 days (median, 110.5 days) for non-radiation oncology providers (log-rank p < 0.0001). Forty-seven episodes (15.2%) were classified as non-evaluable. Among the remaining 262 evaluable episodes, 63 (24.0% of evaluable; 20.4% of total) had no radiation oncologist-authored documentation within 16 weeks despite survival beyond 60 days and were categorized as EBNE. EBNE occurred across treatment sites, including bone and brain indications. A substantial proportion of clinically evaluable palliative RT episodes lacked radiation oncologist-authored documentation. The EBNE framework offers a reproducible method to separate documentation-based non-evaluation from clinical infeasibility, improving transparency in the interpretation of real-world palliative RT outcomes.