Impact of Performance Status and Comorbidity on Palliative Radiation Treatment Tolerance and End-Of-Life Decision-Making

Abstract

PurposePrevious studies have indicated a relationship between functional status and comorbidity on overall survival when treating patients with bone and brain metastases. However, the degree to which these findings have been integrated into modern-day practice remains unknown. This study examines the impact of performance measures, including Karnofsky Performance Status (KPS) and comorbidity, on palliative radiation therapy treatment tolerance and fractionation schedule. The relationship between a shorter fractionation schedule (SFx) and pending mortality is examined.Methods and materialsThis study included patients who were treated with palliative intent to the brain or bone between January 1, 2016 and June 30, 2016. Demographic and medical characteristics collected included KPS score (stratified as good [90-100], fair [70-80], and poor (≤60]), socioeconomic status, comorbidity (binary measure using the Adult Comorbidity Evaluation-27 scale), site of metastatic disease, and treatment facility. Univariable analyses were performed using the Cox proportional hazards regression model to assess the impact of the variables on the prescribed number of fractions (binary measure, ≥10 [long fractionation schedule], and <10 [SFx]), and major treatment interruptions (MTIs; defined as missing ≥3 radiation therapy treatment days or ending treatment prematurely).ResultsA total of 145 patients were eligible for study inclusion, including 95 patients who were treated for bony metastatic disease and 50 patients for brain metastases. High comorbidity (P = .029) and both fair (P = .051) and poor (P = .065) functional status were associated with more frequent MTIs. However, high comorbidity and low KPS score were not associated with shorter treatment plans. In addition, patients with an earlier time to death were not more likely to receive an SFx (P = .871).ConclusionsLow KPS and elevated comorbidity scores predict for a poorer prognosis and more frequent MTIs; however, there was no indication that physicians incorporated this information in the fractionation scheduling.

Clinical predictors of premature radiotherapy terminations in senior adults with oral cavity and laryngeal carcinoma

“…Maebayashi et al reported a rate of 2.9% premature discontinuation among 2141 patients who underwent RT at their institution, which was most commonly due to deterioration of performance status (60% of discontinuations) 12 . In another single‐institution study examining the impact of clinical factors on palliative RT treatment tolerance and fractionation schedule, Perlow et al found that lower Karnofsky Performance Scale (KPS) score and high comorbidity were predictive of increased frequency of major RT treatment interruption 13 . In our analysis, we similarly found that patients with premature RT termination were more likely to have a higher comorbidity CCI score, though this was not found to be statistically significant.…”