Patterns of Care and Course of Symptoms in Palliative Radiotherapy

Oorschot, Birgitt van; Schüler, Michael; Simon, A. L.; Schleicher, Ursula; Geinitz, Hans

doi:10.1007/s00066-011-2231-9

Cited by 28 publications

(22 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Considering that short-course regimens with no or low-grade side effects exist, which often improve symptoms such as pain, dyspnea and hemoptysis, clinicians are wary of withholding a meaningful therapeutic measure for patients with terminal cancer (15)(16)(17)(18). Therefore, prediction tools must not predict short survival times in patients who survive long enough to experience a reduced burden of symptoms, and must also identify the majority of patients will succumb to the disease too early to benefit from the treatment.…”

Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

View full text Add to dashboard Cite

Abstract.Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Radiotherapy also has an established role in the palliation of pain [2]. In our patient, the IT pump was implanted in a location that overlapped with the radiation treatment field.…”

Section: Discussionmentioning

confidence: 99%

Intact Functioning Of Intrathecal Pain Pump Receiving Radiation Therapy

Lauro¹,

Miften²,

Albano³

et al. 2012

J Clin Case Rep

View full text Add to dashboard Cite

Programmable Intrathecal (IT) drug delivery systems are being increasingly used with radiation therapy for cancer treatment and palliation. Ionizing radiation is assumed to cause dysfunction of the programmable IT device. However, the dose limit and safety of the IT drug delivery device used concurrently with radiotherapy have not been extensively documented. Here we report a patient who underwent the implantation of an IT pump during radiotherapy. This device was subsequently directly exposed to radiation. Estimated cumulative doses to the pump were in the range of 1.28 to 9.98 Gy. The IT pump exposed to this high-dose radiation did not pose any risk to the patient or the environment. The device was queried during and after the completion of treatment and found to be functioning without fault. This is the first case description about the successful function of an IT drug delivery device directly exposed to ionizing radiation.

show abstract

“…In one retrospective series of 153 patients, 12% discontinued RT prematurely due to clinical deterioration, lack of effi cacy, or death [41] . It may take 3 -6 weeks to see maximal benefi t in many circumstances [8] .…”

Section: Select Appropriate Patientsmentioning

confidence: 99%