Patient-reported Symptom Burden, Rate of Completion of Palliative Radiotherapy and 30-day Mortality in Two Groups of Cancer Patients Managed With or Without Additional Care by a Multidisciplinary Palliative Care Team

Abstract

The MPCT group was characterized by a higher symptom burden. Prognostic factors such as performance status were not balanced between the two groups. Despite this fact, actuarial overall survival was comparable. Given the high rate of 30-day mortality in the MPCT group, efforts to optimize criteria for initiation of radiotherapy are warranted.

Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review

“…Similarly, in the second study, the authors compared patients undergoing PRT as part of normal clinical practice with subjects managed as part of a multidisciplinary palliative care team. Despite the fact that the second group included significantly more patients with reduced performance status and with higher Edmonton symptom assessment system symptom scores (particularly in terms of pain, fatigue, anxiety, and depression), the actuarial overall survival was comparable among the two patients populations and also the rate of PRT during the last month of life was comparable [ 25 ]. Finally, Spedicato et al reported on an Italian home care experience, which began in the 1990s, for terminally ill cancer patients receiving supportive care by a team of ROs, nurses and psychologists.…”

“…Moreover, in most analyzed studies no details on dose and fractionation of the PRT were reported. Only Nieder et al, in their comparisons between PRT alone or integrated in multidisciplinary management, reported that PRT was delivered with hypofractionated regimens (from 8 Gy × 1 fraction to 3 Gy × 10 fractions), [ 24 , 25 ] while Ishii et al, in their series of esophageal tumors, used a conventional fractionation (40–60 Gy in 2 Gy/fraction) [ 32 ]. However, it should be emphasized that all reports uniformly showed some advantages from integrating PRT with supportive care.…”

“…Moreover, some studies on common clinical practice scenarios suggest that mutual patient referral between PRT and palliative care can be very poor without specific interventions [ 30 , 31 ]. However, other reports suggest that integrating PRT into multidisciplinary management of cancer patients may improve the adequacy of pain and other symptoms treatment, the appropriate use of PRT, and patient and family satisfaction [ 24 , 25 , 27 , 33 , 34 , 35 , 36 ] ( Table 2 ). Furthermore, especially if planned with innovative organizational models, PRT can promote outpatient or home care management [ 17 , 32 ] ( Table 3 ).…”

“…Several solutions have been proposed to overcome these barriers including: the use of tools to improve prognosis prediction [ 18 ], training on PRT for experts in palliative care [ 9 , 10 , 11 ] and on palliative care for ROs [ 13 , 14 , 15 , 16 ], and introduction of pathways and organizational models [ 19 , 20 , 21 , 22 , 23 ], possibly integrated with supportive care programs, specifically dedicated to PRT [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. In particular, PRT rapid response programs in which patient assessment and radiotherapy planning and delivery are performed in the shortest time (possibly on the same day) were proposed [ 37 , 38 , 39 ].…”

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

“…Palliative radiotherapy (PRT) is among the cornerstones of oncological approaches in patients with incurable cancer (1). In our institution, which has a dedicated PRT program that serves a small and scattered population of less than 200,000 inhabitants in rural North-Norway (large parts of Nordland County with a total of population of 243,000), overtreatment and 30-day mortality (30DM) has long been a topic of research (2)(3)(4)(5)(6). The first comprehensive analysis related to the time period 2007-2009 (7).…”