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BackgroundPalliative radiotherapy (PRT) can significantly improve quality of life for patients dying of cancer with bone metastases. However, an aggressive cancer treatment near end of life is an indicator of poor-quality care. But the optimal rate of overall palliative RT use near the end of life is still unknown. We sought to determine the patterns of palliative radiation therapy (RT) utilization in patients with bone metastases towards their end of life in a population-based, publicly funded health care system.MethodsAll consecutive patients with bone metastases treated with RT between 2007 and 2011 were identified in a provincial Canadian cancer registry database. Patients were categorized as receiving RT in the last 2 weeks, 2–4 weeks, or >4 weeks before their death. Associations between RT fractionation utilization by these categories, and patient and provider characteristics were assessed through logistic regression.ResultsOf the 16,898 courses 1734 (10.3) and 709 (4.2 %) were prescribed to patients in the last 2–4 weeks and <2 weeks of their life, respectively. Primary lung (8 %) and gastrointestinal (6.9 %) cancers received palliative RT more commonly in the last 2 weeks of life (OR 3.72 [2.86–4.84] & 3.33 [2.42–4.58] respectively, p <0.001). Among the 709 patients who received RT in the last 2 weeks of life, 350 (49), 167 (24), and 127 (18 %) were for spine, pelvis, and extremity metastases, respectively. RT was prescribed most frequently to spine (5 %) and extremity (4 %) metastases p <0.001 in the last two weeks of life, though only varied between 1 % (sternum) and 5 % (spine) by site of metastases. Single fraction RT was prescribed more commonly in the last 2 weeks of life (64.2 %), compared to individuals who received RT 2–4 weeks (54.5), and >4 weeks (47.9 %) before death (p <0.001).ConclusionsThis population-based analysis found that only 4 % of patients with bone metastases received radiation therapy during the last 2 weeks of their life in our population-based, publicly funded program, though it was significantly higher in patients with lung cancer and those with metastases to the spine or extremity. Appropriately, use of multiple fractions palliative RT was less common in patients closer to death.

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In general, patients with malignant tumours of the skull base have a poor prognosis. Treatment may have a disfiguring physical and disabling mental effect on patients. To evaluate the effect of treatment on physical and mental quality of life in patients with skull base malignancy, we conducted a cross-sectional patient survey of 18 patients treated for such tumours, using the University of Washington (version 4) quality of life questionnaire and the hospital anxiety and depression scale. The total quality of life score (median value) was 980 (550-1125). Patients with anterior skull base malignancy scored lower than those with lateral skull base malignancy (p=0.003). In general, the worst individual domain scores were: mood (64 per cent); activity (69 per cent); and, specifically for patients with anterior skull base malignancy, taste (54 per cent, p=0.004) and anxiety (60 per cent, p=0.034). One-third of skull base cancer patients were at risk of suffering from mental distress and psychiatric morbidity (indicated as a score of more than seven on the hospital anxiety and depression scale).