Palliative Radiotherapy

Lutz, S; Korytko, Timothy; Nguyen, Janet; Khan, Luluel; Chow, Edward; Corn, Benjamin W.

doi:10.1097/ppo.0b013e3181f28b4d

Cited by 39 publications

(5 citation statements)

References 79 publications

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“…Finally, a more convenient and appropriate single fraction RT (SFRT) was prescribed in 64 % of the palliative RT courses to patients who died within 2 weeks of receiving RT. Multiple studies have shown and confirmed the benefit and efficacy of SFRT near end of life [ 18 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Utilization of palliative radiotherapy for bone metastases near end of life in a population-based cohort

et al. 2016

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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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Section: Discussionmentioning

confidence: 99%

Utilization of palliative radiotherapy for bone metastases near end of life in a population-based cohort

et al. 2016

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“…1 The goals of care focus primarily on the prolongation of survival and palliation of symptoms rather than curing. 2 , 3 Palliative radiation therapy (RT) is frequently employed in patients with incurable NSCLC, and the most common radiation treatment sites are the brain, thorax, and bone. 4 Despite its ability to stabilize or improve symptoms, 3 prior studies have shown significant variations in the use of palliative RT that ranged from 31% to 66% in patients with incurable disease.…”

Section: Introductionmentioning

confidence: 99%

Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer

Lam

Cronin

et al. 2018

Advances in Radiation Oncology

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PurposePalliative radiation therapy (RT) can improve quality of life but also incurs time and financial costs. The aim of this study was to evaluate factors associated with use and intensity of palliative RT for incurable non-small cell lung cancer (NSCLC).Methods and materialsThis was a retrospective analysis of Medicare's Surveillance, Epidemiology and End Results data. We identified patients who were diagnosed with incurable (American Joint Committee on Cancer 6th edition stage IIIB with malignant effusion or stage IV) NSCLC between 2004 and 2011. Univariable and multivariable logistic regressions were used to identify factors associated with the receipt of palliative RT and the use of >10 fractions during the first course of radiation. Among patients who were treated with radiation, freestanding versus hospital-based center information was collected on the basis of the location of the RT delivery claim.ResultsAmong 55,258 patients with incurable NSCLC, 38% (21,053 patients) received palliative RT during the first year after diagnosis. Among patients who received RT, 56% (11,717 patients) received >10 fractions. On multivariable analysis, factors associated with greater RT use included younger age group (overall P < .01), lower modified Charlson comorbidity score (overall P < .01), female sex (odds ratio [OR]: 1.1; P < .01), marital status (OR: 1.1; P < .01), and chemotherapy use (OR: 3.6; P < .01). Predictors for >10 fractions were chemotherapy use (OR: 1.7; P < .01) and treatment at a freestanding versus hospital-based facility (58% vs 43%; OR: 1.7; P < .01).ConclusionsMore than a third of patients diagnosed with incurable lung cancer receive palliative RT and 56% received >10 fractions. The use of RT varied by region and patient characteristics, and patients treated at freestanding RT centers were more likely to receive >10 fractions. Further research into factors that influence treatment decisions including potential financial incentives may contribute to the high value and strategic utilization of palliative RT.

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“…Radiotherapy (RT) constitutes a treatment modality with a very favorable risk profile for symptom control in advanced stage cancer patients [1] , [2] . Palliative RT has proven to be effective for the treatment of painful bone metastasis and for stabilizing symptomatic as well as emergency situations like hemoptysis or spinal cord compression [3] , [4] , [5] , [6] .…”

Section: Introductionmentioning

confidence: 99%

Single-institution analysis of the prevalence, indications and outcomes of end-of-life radiotherapy

Christ

Schettle

Seiler

et al. 2021

Clinical and Translational Radiation Oncology

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Palliative Radiotherapy

Cited by 39 publications

References 79 publications

Utilization of palliative radiotherapy for bone metastases near end of life in a population-based cohort

Utilization of palliative radiotherapy for bone metastases near end of life in a population-based cohort

Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer

Single-institution analysis of the prevalence, indications and outcomes of end-of-life radiotherapy

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