Palliative Radiotherapy During the Last Month of Life: Have COVID-19 Recommendations Led to Reduced Utilization?

Nieder, Carsten; Haukland, Ellinor; Mannsåker, Bård; Yobuta, Rosalba

doi:10.21873/invivo.12304

Cited by 15 publications

(19 citation statements)

References 15 publications

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“…In general, radiotherapy providers should try to achieve the goals of palliative treatment without causing unnecessary burden, both regarding side effects, costs and inconvenience [11][12][13]. Quality measures such as incomplete radiotherapy and treatment in the last 30 days of life can be monitored, both on longitudinal institutional and larger levels [14,15].…”

Section: Discussionmentioning

confidence: 99%

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

Nieder¹,

Mannsåker²,

Yobuta³

2022

Cureus

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Introduction:The recently published METSSS model, which was developed for prediction of survival after palliative radiotherapy, includes age, sex, cancer type, localization of distant metastases, Charlson-Deyo comorbidity score and radiotherapy site. Its ability to predict other relevant endpoints has not been studied yet. Therefore, this exploratory study analyzed the endpoints "unplanned termination of radiotherapy" and "treatment in the last 30 days of life" in the METSSS-defined risk groups (low/medium/high).Methods: The risk group was assigned in the METSSS online calculator for our patient cohort with nonhematological malignancies treated between 2009 and 2014 during the first course of treatment (resembling details of the original METSSS study). All patients were treated with classical palliative dose/fractionation regimes such as five fractions of 4 Gy, 10 fractions of 3 Gy or 13 fractions of 3 Gy. No stereotactic high-dose radiation was utilized. Given that single-fraction radiotherapy cannot be discontinued, patients treated with 8 Gy x1 for uncomplicated painful bone metastases were excluded. Both completed and discontinued multifraction radiotherapy courses (at least two fractions intended) were included.Results: The study included 290 patients, 19 of whom failed to complete their prescribed course of palliative radiotherapy (7%). Thirty-nine (13%) were irradiated in the last 30 days of life. Only one patient was classified as low-risk according to the METSSS model (medium: 15, high: 274). Only Eastern Cooperative Oncology Group (ECOG) performance status (PS) was significantly associated with incomplete treatment. All 16 patients with low/medium METSSS risk scores completed their prescribed course of radiotherapy, compared to the 93% completion rate in the high-risk group, p=0.41. With regard to treatment in the last 30 days of life, ECOG PS, metastases to brain, liver and lung, and the number of prescribed fractions were statistically significant. One patient with a low/medium METSSS risk score was treated in the last 30 days of life (6%), compared to 14% in the high-risk group, p=0.49. Conclusion:Unexpected imbalances in the METSSS risk group size resulted in lower statistical power than anticipated. Patients with low/medium METSSS risk scores performed numerically better. However, other predictive factors, especially ECOG PS, which is not part of the METSSS model, maybe more relevant. Further efforts towards the application of the model beyond its original objective cannot be recommended.

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Section: Discussionmentioning

confidence: 99%

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

Nieder¹,

Mannsåker²,

Yobuta³

2022

Cureus

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“…Single fraction utilization ranged from 0 to 59%. Given that our institution regularly has evaluated this quality of care indicator and found largely stable rates despite efforts to improve the prediction of short survival [ 14 , 18 ], we gradually implemented newer altered-fractionation regimens to shorten the overall treatment time. While the vast majority of our patients receive traditional short-course regimens such as 8 Gy x1 or 4 Gy x5, a selected proportion of patients with good performance status (mostly 0-2) who are not candidates for ablative SABR/SRS approaches represent a group that is not always easy to manage.…”

Section: Discussionmentioning

confidence: 99%

“…This transition began before the COVID-19 pandemic. However, our recent pre-versus post-COVID-19 analysis showed reduced utilization of palliative radiotherapy with 10 or more fractions (p=0.008) during the pandemic [ 18 ]. The markedly higher number of patients treated with non-ablative, high-EQD2 regimens in 2020, which is evident from Figure 1 , likely is a result of the COVID-19 pandemic, which has led to deferred systemic treatment in patients with upfront oligometastases or oligoprogression during a drug holiday.…”

Section: Discussionmentioning

confidence: 99%

“…We also adopted the single fraction 12-or 16-Gy concept for bone metastases not suitable for a single fraction of 8 Gy published by Nguyen et al [17]. As already reported, in the first half of 2020 still 9% of our patients received PRT during the final 30 days of life [18]. The aim of the present analysis was to compare the rate of PRT30 with the traditional >2 weeks regimens to that of the newer ≤2 weeks regimens, both of whom prescribed to selected patients with an estimated survival justifying a two-goal concept (symptom palliation combined with in-field control).…”

Section: Introductionmentioning

confidence: 99%

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Shortened Palliative Radiotherapy Results in a Lower Rate of Treatment During the Last Month of Life

Nieder¹,

Haukland²,

Mannsåker³

2022

Cureus

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IntroductionPalliative radiotherapy (PRT) during the last month of life (PRT30) should be avoided because relevant clinical benefits are unlikely to occur. While traditional short-course fractionation regimens are suitable for most patients, a minority may derive gains from higher doses of PRT. Compared to older regimens such as 13 fractions of 3 Gy, more hypofractionated, non-ablative concepts with reduced overall treatment time are not well studied. MethodsRetrospective analysis (2017-2020) of 107 patients treated to metastatic lesions (one or two target volumes per patient) with traditional >2 weeks regimens or newer ≤2 weeks regimens, e.g. seven fractions of 5 Gy or five fractions of 6 Gy. ResultsFailure to complete radiotherapy was registered in 8% of patients (traditional fractionation) and 1%, respectively (p=0.12). Moderate rates of PRT30 were observed (11% and 6%, respectively, p=0.44). PRT30 was more likely in patients irradiated for brain or lymph node metastases. Utilization of newer ≤2 weeks regimens was highest in 2020, presumably as a result of the coronavirus disease 2019 (COVID-19) pandemic. ConclusionThe implementation of newer fractionation regimens for selected patients has resulted in acceptable rates of non-completion and PRT30. Optimal selection criteria remain to be determined. Established, guidelineendorsed short-course regimens such as five fractions of 4 Gy and 8-Gy single fractions continue to represent important PRT approaches.

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“…Of 61 patients treated during the pandemic, 1% received PRT each business day, and 41% for bone metastases. These findings indicated a significant reduction in Norway's recommendations for PRT for bone metastases Nieder [13].…”

Section: Medical Communitymentioning

confidence: 97%

Palliative Care for the Late-Stage Cancer Patient During the COVID-19 Era: A Report of the Challenges

Villa-Guillen

2021

OAJBS

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Objective: To report the main factors of oncological palliative care in the late-stage cancer patient affected during the pandemic of COVID-19, as recognized by the international medical community. Methods: We followed the PRISMA guidelines and searched on the electronic database PubMed using the search terms: palliative care, neoplasms, cancer, pandemic, and quality of life. We excluded articles of recommendations and guidelines, opinion articles, conference abstracts, or articles published before March 11 th , 2020, the official WHO date of the COVID-19 pandemic.Results: Seven studies satisfied the inclusion criteria of 1,400. Those research articles are from Norway,

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Palliative Radiotherapy During the Last Month of Life: Have COVID-19 Recommendations Led to Reduced Utilization?

Cited by 15 publications

References 15 publications

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

Dual Use of the METSSS Model Predicting Survival After Palliative Radiotherapy: An Exploratory Analysis

Shortened Palliative Radiotherapy Results in a Lower Rate of Treatment During the Last Month of Life

Palliative Care for the Late-Stage Cancer Patient During the COVID-19 Era: A Report of the Challenges

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