Purpose. To analyze pattern of care and survival after palliative radiotherapy (RT) in patients managed exclusively by regular oncology staff or a multidisciplinary palliative care team (MPCT) in addition. Methods. Retrospective analysis of 522 RT courses. Comparison of Two Groups: MPCT versus none. Results. We analyzed 140 RT courses (27%) with MPCT care and 382 without it. The following statistically significant differences were observed: 33% of female patients had MPCT care versus only 23% of male patients and 37% of patients <65 years had MPCT care versus only 22% of older patients. MPCT patients were more likely to have poor performance status and liver metastases. In the MPCT group steroid and opioid use was significantly more common. Dose-fractionation regimens were similar. Median survival was significantly shorter in the MPCT group, 3.9 versus 6.9 months. In multivariate analysis, MPCT care was not associated with survival. Adjusted for confounders, MPCT care reduced the likelihood of incomplete RT by 33%, . Conclusions. Patterns of referral and care differed, for example, regarding age and medication use. It seems possible that MPCT care reduces likelihood of incomplete RT. Therefore, the impact of MPCT care on symptom control should be investigated and objective referral criteria should be developed. 1. Background Patients with cancer referred to palliative radiotherapy often experience considerable burden from disease-related symptoms such as pain, bleeding, or neurological deficits, which may improve after successful completion of treatment [1]. Due to high rates of symptom improvement, radiotherapy has become a mainstay in multidisciplinary care for patients with incurable cancer. However, large variations exist in radiotherapy regimens, supportive therapy, resource utilization, involvement of other medical disciplines and professions, and care setting [2]. Several studies have shown that patients with noncurable metastatic cancer might receive too aggressive and long-standing treatment during the last months of life [3–7]. The focus on optimal supportive care may be lost or prioritized too late. Recently, a randomized trial of early palliative care for patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC), which recruited patients in the time period between 2006 and 2009, was published [8, 9]. This single institution trial included 151 patients. Early palliative care integrated with standard oncology care was compared to standard oncology care alone. Patients assigned to the experimental arm consulted with a member
References
[1]
B. van Oorschot, D. Rades, W. Schulze, G. Beckmann, and P. Feyer, “Palliative radiotherapy—new approaches,” Seminars in Oncology, vol. 38, no. 3, pp. 443–449, 2011.
[2]
J. D. Murphy, L. M. Nelson, D. T. Chang, L. K. Mell, and Q. T. Le, “Patterns of care in palliative radiotherapy: a population-based study,” Journal of Oncology Practice, vol. 9, pp. e220–e227, 2013.
[3]
B. A. Gadagnolo, K. P. Liao, L. Elting, S. Giordano, T. A. Buchholz, and Y. C. Shih, “Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States,” Journal of Clinical Oncology, vol. 31, pp. 80–87, 2013.
[4]
C. Nieder, T. Toll？li, J. Norum, A. Pawinski, and R. M. Bremnes, “A population-based study of the pattern of terminal care and hospital death in patients with non-small cell lung cancer,” Anticancer Research, vol. 32, no. 1, pp. 189–194, 2012.
[5]
N. S. Kapadia, R. Mamet, C. Zornosa, J. C. Niland, T. A. D'Amico, and J. A. Hayman, “Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer,” Cancer, vol. 118, pp. 4339–4345, 2012.
[6]
S. Gripp, S. Mjartan, E. Boelke, and R. Willers, “Palliative radiotherapy tailored to life expectancy in end-stage cancer patients: reality or myth?” Cancer, vol. 116, no. 13, pp. 3251–3256, 2010.
[7]
A. B. Chen, A. Cronin, J. C. Weeks et al., “Palliative radiation therapy practice in patients with metastatic non-small cell lung cancer: a cancer care outcomes research and surveillance consortium (CanCORS) study,” Journal of Clinical Oncology, vol. 31, pp. 558–664, 2013.
[8]
J. S. Temel, J. A. Greer, A. Muzikansky et al., “Early palliative care for patients with metastatic non-small-cell lung cancer,” The New England Journal of Medicine, vol. 363, no. 8, pp. 733–742, 2010.
[9]
J. A. Greer, W. F. Pirl, V. A. Jackson et al., “Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer,” Journal of Clinical Oncology, vol. 30, no. 4, pp. 394–400, 2012.
[10]
L. Khan, J. Kwong, J. Nguyen et al., “Comparing baseline symptom severity and demographics over two time periods in an outpatient palliative radiotherapy clinic,” Supportive Care in Cancer, vol. 20, no. 3, pp. 549–555, 2012.
[11]
W. Jensen, L. Bialy, G. Ketels, F. T. Baumann, C. Bokemeyer, and K. Oechsle, “Physical exercise and therapy in terminally ill cancer patients: a retrospective feasibility analysis,” Support Care Cancer, 2014.
[12]
A. Caissie, S. Culleton, J. Nguyen et al., “EORTC QLQ-C15-PAL quality of life scores in patients with advanced cancer referred for palliative radiotherapy,” Supportive Care in Cancer, vol. 20, pp. 841–848, 2012.
[13]
E. Pituskin, A. Fairchild, J. Dutka et al., “Multidisciplinary team contributions within a dedicated outpatient palliative radiotherapy clinic: a prospective descriptive study,” International Journal of Radiation Oncology Biology Physics, vol. 78, no. 2, pp. 527–532, 2010.
[14]
S. Yennurajalingam, S. Frisbee-Hume, J. L. Palmer et al., “Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer,” Journal of Clinical Oncology, vol. 31, pp. 3076–3082, 2013.
[15]
B. Movsas, J. Moughan, L. Sarna et al., “Quality of life supersedes the classic prognosticators for long-term survival in locally advanced non-small-cell lung cancer: an analysis of RTOG 9801,” Journal of Clinical Oncology, vol. 27, no. 34, pp. 5816–5822, 2009.
[16]
M. Poon, K. Dennis, C. Deangelis et al., “A prospective study of gastrointestinal radiation therapy-induced nausea and vomiting,” Support Care Cancer, 2014.
