The role of radiation therapy in palliative care of children with advanced cancer: Clinical outcomes and patterns of care

Abstract

Background: There are few published data to guide the use and timing of palliative radiation therapy (RT) in children. We aimed to determine the clinical outcomes of palliative RT in children and the relationship with palliative care and hospice referrals.Procedure: A retrospective chart review was performed on all patients younger than 18 years who received palliative RT in our clinic from January 2005 to January 2015. Results:In the specified time period, 50 children underwent 83 courses of palliative RT. Median survival after treatment was 124 days (range, 1-1141 days). Fifteen courses were delivered to children in the last 30 days of life (dol). Palliative RT was successful in 89% of courses delivered before the last 30 dol versus 28% of courses delivered in the last 30 dol (p < 0.0001, Fisher's exact test). At the time of data collection, 43 children were deceased. Altogether, 88% of children who received palliative RT were also referred to our institution's pediatric palliative care team or to hospice at some time in their course. Of the children who died, 74% were referred to hospice and 34% were on hospice while receiving palliative RT. For children not already on hospice, the median time to hospice referral was 96 days after the last fraction (range, 0-924 days). Conclusions:Palliative RT is effective in children with advanced cancer, although less so in the last 30 dol. With careful care coordination and multidisciplinary collaboration, RT can be successfully integrated into supportive and end-of-life care for children with advanced cancer. K E Y W O R D Send of life, hospice, palliative care, patterns of care, radiation oncology, radiotherapy

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

“…In our study, the vast majority of RT courses were completed (92%), similar to the series by Varma et al. and Rahn et al where 90% and 93% of patients completed treatment, respectively . In our study, the most common indication for palliative RT was radiologic progression of oligometastatic asymptomatic disease (39%).…”

Recommendations for the treatment of children with radiotherapy in low‐ and middle‐income countries (LMIC): A position paper from the Pediatric Radiation Oncology Society (PROS‐LMIC) and Pediatric Oncology in Developing Countries (PODC) working groups of the International Society of Pediatric Oncology (SIOP)

“…Palliative radiotherapy in children is effective and durable especially when used as part of a palliative care plan. [31][32][33][34] However, knowledge and utilization of pediatric radiotherapy among pediatric oncologists is poor even in HIC. 35 The responsibility of the team is to ensure that each child is assessed according to the best available standards, treated according to All pediatric patients requiring RT should be seen and assessed by the RO in clinic prior to the RT planning appointment.…”

“…[31][32][33][34] However, knowledge and utilization of pediatric radiotherapy among pediatric oncologists is poor even in HIC. 35 Single fractions of radiotherapy at doses of 4-8 Gy delivered to single or parallel opposed fields is simple to deliver and should be offered by all radiotherapy centers.…”

Palliative radiotherapy for pediatric patients: Parental perceptions of indication, intent, and outcomes

“…In the pediatric population, curative radiation therapy is often used less than other modalities due to concerns regarding adverse effects and secondary malignancies . Curiously, though these concerns are somewhat alleviated in palliative therapy due to the lower dosage used compared to curative therapy, pRT in children remains underutilized . Several factors may contribute to this phenomenon.…”

“…3 Curiously, though these concerns are somewhat alleviated in palliative therapy due to the lower dosage used compared to curative therapy, pRT in children remains underutilized. 5 Several factors may contribute to this phenomenon. Parents are often optimistic regarding their child's likelihood of survival, and they desire intensive treatment for their child until the end of life, hoping to achieve cure or to extend life.…”