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Navarro-López V, Cardozo-Burgos L, Urbe-Murguizu U, Cancelas-Felgueras MD, Del-Valle-Gratacós M. Transcranial direct current stimulation in the management of pain in oncology patients. A systematic review and meta-analysis with meta-regression of randomized controlled trials. Disabil Rehabil 2024:1-11. [PMID: 39340309 DOI: 10.1080/09638288.2024.2399227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE To evaluate the efficacy of transcranial direct current stimulation (tDCS) in pain management in subjects with oncologic process. MATERIAL AND METHODS Several databases were searched in December 2023. Randomized Controlled Trials that evaluated the application of tDCS on pain in adults with oncologic process were selected. Random-effects meta-analysis with 95%CI were used to quantify the change scores in pain between tDCS and control groups. RESULTS Six trials with 482 participants were included. There were significant differences in favor of tDCS in pain intensity in surgical oncology patients compared to sham stimulation (p < 0.001). Non-surgical patients showed no significant effect. Meta-regression analysis in this group of patients showed that the timing of the evaluation moderated the effect of tDCS on pain (p= .042), with longer time after tDCS being associated with greater pain reduction. CONCLUSIONS The application of a-tDCS for at least 20 min, with a current density higher than 0.057 mA/cm2, applied over M1, left DLPFC, or the insula area, between 2-5 sessions appears to be an effective and safe treatment of pain in surgical oncology patients compared to sham. The tDCS appears to be more effective for high-intensity pain, and in the long term.
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Affiliation(s)
- Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Movement Analysis, Biomechanics, Ergonomics, and Motor Control Laboratory, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Mahoney MT, Linkowski LC, Wu TC, Chen JJ, Neilsen BK, Thompson PS, Mix MD, Sura KT, Mattes MD. Analysis of Oncology and Radiation Therapy Representation on the National Board of Medical Examiners Official Practice Material for the United States National Standardized Medical Board Examinations. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024:10.1007/s13187-024-02475-0. [PMID: 38997529 DOI: 10.1007/s13187-024-02475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/14/2024]
Abstract
Radiation therapy (RT) is a critical component of multidisciplinary cancer care, but has inconsistent curricular exposure. We characterize the radiation oncology (RO) content on the standardized undergraduate medical examinations by comparing its context and prevalence with other domains in oncology. National Board of Medical Examiners (NBME) self-assessments and sample questions for the United States Medical Licensing Exam (USMLE) Steps 1-3 and NBME clinical science shelf examinations were accessed (n = 3878). Questions were inductively analyzed for content pertaining to oncology and treatment modalities of RT, systemic therapy (ST), and surgical intervention (SI). Questions were coded using USMLE Physician Tasks/Competencies and thematic analysis. Descriptive statistics and analyses using the Kruskal-Wallis test are reported. A total of 337 questions (8.6%) within the USMLE and shelf exams included oncology content, with 101 questions (2.6%) referencing at least one cancer treatment modality (n = 35 RT, 45 ST, 57 SI). Treatment questions were more common on USMLE Step 2 CK (n = 35/101, 32%) compared to Step 1 (n = 23/101, 23%) and Step 3 (n = 8/101, 8%) (p < 0.001). RT was significantly less likely to be the correct answer (2/35, 6%) compared to ST (4/45, 9%) and SI (18/57, 32%) (p = 0.003). Therapeutic oncology questions are uncommon on the examination material, with an under-representation of radiation-related content, and contextual bias favoring surgical approaches. We advocate for greater RO involvement in the content creation of such examinations to help trainees better understand multidisciplinary cancer care.
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Affiliation(s)
- Mary T Mahoney
- Transitional Year Residency Program, Garnet Health Medical Center, 707 East Main St, Middletown, NY, 10940, USA.
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, USA.
| | - Lauren C Linkowski
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Trudy C Wu
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jie Jane Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Beth K Neilsen
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Petria S Thompson
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Michael D Mix
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Karna T Sura
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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O'Leary C, Cleary S, Linane H, Hamilton B, Jennings M, Lee Y, Lavan N, O'Reilly M, Twomey M. Palliative radiotherapy and the introduction of a Rapid Access Palliative Clinic in a national radiation oncology network. Ir J Med Sci 2024; 193:577-583. [PMID: 37606800 PMCID: PMC10961263 DOI: 10.1007/s11845-023-03494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/09/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Palliative radiotherapy (PRT) is commonly used to treat symptoms of advanced cancer. PRT has been associated with elevated 30-day mortality (30DM). A Rapid Access Palliative Clinic (RAPC) can streamline the treatment process for patients receiving treatment. AIMS We reviewed the PRT practices in a radiation oncology network in Ireland, and the implementation of a RAPC. Patient outcomes were assessed to inform future treatment decisions. METHODS A retrospective review of all patients who received PRT over 6 months in 2018 in St. Luke's Radiation Oncology Network (SLRON) was undertaken. We assessed 30DM rates, demographics and referral to specialist palliative care (SPC) services. Subsequently, a retrospective analysis was conducted of a RAPC which ran for 6 months from 2019 to 2020. We assessed treatment data and mortality. RESULTS Over 6 months, 645 patients commenced PRT in the SLRON. The 30DM for this cohort was 15.8% (n = 102), with most patients having lung primaries. Of the 30DM cohort, only 55% (n = 56) were referred to SPC services and only 26.4% (n = 27) had performance status recorded. Over 6 months, 40 patients attended 28 RAPCs. Of these, 88% (n = 35) received PRT. Single fraction therapy was utilised in 60% and 48% of patients underwent CT simulation and treatment on the same day. Ultimately, 75% of patients received SPC referral. CONCLUSIONS Referral rates to SPC services and documentation of performance status were low in our 30DM retrospective review cohort. The RAPC facilitated quick treatment turnaround, fewer hospital visits and referral to SPC services.
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Affiliation(s)
- Cian O'Leary
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland.
| | - Sinead Cleary
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Hannah Linane
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Barbara Hamilton
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Michelle Jennings
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Yvonne Lee
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Naomi Lavan
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Maeve O'Reilly
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
| | - Marie Twomey
- St. Luke's Hospital Rathgar, Highfield Road, Rathgar, Dublin 6, Ireland
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Maemoto H, Kushi K, Owan I, Ariga T, Heianna J, Nishie A. Deterioration of Performance Status during Palliative Radiotherapy Suggests a Significant Short Survival Duration: Indicating the Necessities for Considering Radiotherapy Discontinuation. Curr Oncol 2024; 31:1752-1761. [PMID: 38668036 PMCID: PMC11049355 DOI: 10.3390/curroncol31040133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Discontinuation of palliative radiotherapy due to a patient's declining general condition poses a clinical dilemma for palliative care physicians. This study aimed to investigate the survival duration of patients whose performance status (PS) deteriorated during palliative radiotherapy and inform decisions regarding early treatment discontinuation. We retrospectively analyzed data from patients referred from our institute's palliative care department who underwent ≥10 fractions of palliative radiotherapy between March 2017 and December 2021. PS was assessed using the Eastern Cooperative Oncology Group (ECOG) scale. Survival duration was calculated from the final day of palliative radiotherapy to death using the Kaplan-Meier method. A total of 35 patients underwent palliative radiotherapy. Seven (20%) experienced deterioration in ECOG PS during treatment. Their median survival duration was significantly shorter at 22 days (95% confidence interval: 1-94 days) compared to 125 days (95% confidence interval: 82-150 days) for the 28 patients whose PS remained stable (p = 0.0007). Deterioration in ECOG PS during palliative radiotherapy signifies a markedly shorter survival duration. Careful assessment of a patient's condition throughout treatment is crucial, and early discontinuation should be considered if their general health worsens rather than strictly adhering to the initial schedule.
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Affiliation(s)
- Hitoshi Maemoto
- Division of Radiation Oncology, NHO Okinawa Hospital, Okinawa 901-2214, Japan
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
| | - Kazuaki Kushi
- Division of Palliative Care, NHO Okinawa Hospital, Okinawa 901-2214, Japan
| | - Isoko Owan
- Division of Pulmonary Medicine, NHO Okinawa Hospital, Okinawa 901-2214, Japan;
| | - Takuro Ariga
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
- Health Information Management Center, University of the Ryukyus Hospital, Okinawa 903-0213, Japan
| | - Joichi Heianna
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
| | - Akihiro Nishie
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0213, Japan; (T.A.); (J.H.); (A.N.)
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O'Reilly E, Lao L, Woodhouse B, Sharples K, Print C, Lawrence B. Palliative radiotherapy is effective for both well- and poorly differentiated neuroendocrine neoplasms. J Med Imaging Radiat Oncol 2024; 68:94-102. [PMID: 37898955 DOI: 10.1111/1754-9485.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION The outcomes of palliative radiation therapy (RT) for neuroendocrine neoplasms (NEN) are seldom reported. We investigated outcomes following palliative radiotherapy in a cohort of patients with NENs. We hypothesised that well-differentiated NEN will be less likely to have a clinical response than poorly differentiated NEN. METHODS Patients who received at least one course of palliative RT were identified using the New Zealand NETwork! Registry. Patients with Merkel cell carcinoma, pulmonary small cell carcinoma or asymptomatic patients were excluded. Clinical response to RT within 90 days and overall survival were analysed alongside clinical variables (fractionation, RT site, tumour differentiation and tumour primary site). RESULTS The cohort comprised 79 patients, with 147 courses of palliative RT delivered. Clinical response was measurable for 100 courses, with clinical response rate of 76%. A course delivered to a well-differentiated NEN was associated with 2.02-fold (95% CI 0.67, 6.12; P = 0.21) increase in odds of a clinical response compared to a poorly differentiated NEN. Median overall survival from the first fraction of RT was 94 days (95% CI 80, 138 days). Overall survival was higher in well-differentiated NEN than in poorly differentiated NEN (HR 0.2, 95% CI 0.10-0.40, P-value < 0.001); 30-day mortality was 7%. There were significantly reduced odds of clinical response for non-bone sites, and for courses >10 fractions compared to a single fraction. CONCLUSION Palliative RT is an appropriate option for management of symptoms in patients with both well- and poorly differentiated metastatic NEN.
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Affiliation(s)
- Eileen O'Reilly
- Radiation Oncology, Te Whatu Ora - Health New Zealand Waitaha Canterbury, Christchurch, New Zealand
| | - Louis Lao
- Radiation Oncology, Te Whatu Ora Te Toka Tumai Auckland, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
| | - Braden Woodhouse
- Cancer Trials New Zealand, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
| | - Katrina Sharples
- Cancer Trials New Zealand, University of Otago, Dunedin, New Zealand
| | - Cris Print
- Department of Molecular Medicine and Pathology, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
| | - Ben Lawrence
- Medical Oncology, Te Whatu Ora Te Toka Tumai Auckland, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
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Oldenburger E, Isebaert S, Coolbrandt A, Van Audenhove C, Haustermans K. The use of electronic Patient Reported Outcomes in follow-up after palliative radiotherapy: A survey study in Belgium. PEC INNOVATION 2023; 3:100243. [PMID: 38169899 PMCID: PMC10758946 DOI: 10.1016/j.pecinn.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024]
Abstract
Objective Electronic Patient-Reported Outcome Measures (ePROMs) could be used to monitor patients' symptoms after treatment. However, ePROM implementation in clinical practice has been challenging, especially in (palliative) radiation oncology. The aim of this study was to explore the opinions of healthcare providers (HCP) active in radiation oncology in Belgium on the use of ePROMs for symptom follow-up after palliative radiotherapy. Methods An anonymous online survey was conducted with different HCP in radiation oncology in Belgium. Participants were recruited through several professional organizations with approximately 390 members actively working in the field of radiation oncology. The survey used was a self-developed questionnaire, based on existing literature on implementation of (e)PROMs in cancer care, our previous research on this topic as well as our personal experience in the field of oncology and palliative care. Results Of the 128 respondents, 26% had experience with ePROMs in clinical practice. Eighty-four percent considered ePROMs beneficial for patients' health and symptom knowledge, symptom self-management and active participation in care. ePROMs could help HCP to focus on detection of relevant symptoms and improve their management. Almost 75% were willing to implement and use ePROMs. Assigning ePROM introduction and follow-up to a dedicated person, such as a nurse navigator, was suggested to promote ePROM implementation and use in clinical practice. Conclusion Despite limited experience with ePROMs in clinical care for palliative radiotherapy patients, the majority of respondents is willing to implement and use ePROMs for this particular patient population. Innovation This is one of the first studies specifically focusing on experiences and opinions of HCP in radiation oncology on the use of ePROMs for symptom follow-up in palliative radiotherapy. HCP should be actively involved in implementation of ePROMs after palliative radiotherapy, to translate their vision of their ideals in practice.
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Affiliation(s)
- Eva Oldenburger
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
- Department of Palliative Care, University Hospitals Leuven, Belgium
| | - Sofie Isebaert
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Annemarie Coolbrandt
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | | | - Karin Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
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Rizvi F, Korst MR, Young M, Habib MH, Kra JA, Shah A, Mayer TM, Saraiya B, Jarrín OF, Mattes MD. Pilot Study Evaluating Cross-Disciplinary Educational Material to Improve Patients' Knowledge of Palliative Radiation Therapy. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1466-1470. [PMID: 36905555 DOI: 10.1007/s13187-023-02283-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
Palliative radiation therapy (PRT) is underutilized, partially due to misconceptions about its risks, benefits, and indications. The objective of this pilot study was to determine if patients with metastatic cancer would gain knowledge from educational material describing PRT and perceive it as useful in their care. A one-page handout conveying information about the purpose, logistics, benefits, risks, and common indications for PRT was offered to patients undergoing treatment for incurable, metastatic solid tumors in one palliative care clinic and four medical oncology clinics. Participants read the handout, then completed a questionnaire assessing its perceived value. Seventy patients participated between June and December 2021. Sixty-five patients (93%) felt they learned from the handout (40% learned "lots"), and 69 (99%) felt the information was useful (53% "very useful"). Twenty-one patients (30%) were previously unaware that PRT can relieve symptoms, 55 (79%) were unaware that PRT can be delivered in five treatments or less, and 43 (61%) were unaware that PRT usually has few side effects. Sixteen patients (23%) felt they currently had symptoms not being treated well enough, and 34 (49%) felt they had symptoms that radiation might help with. Afterwards, most patients felt more comfortable bringing symptoms to a medical oncologist's (n = 57, 78%) or radiation oncologist's (n = 51, 70%) attention. Patient-directed educational material about PRT, provided outside of a radiation oncology department, was perceived by patients as improving their knowledge and adding value in their care, independent of prior exposure to a radiation oncologist.
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Affiliation(s)
- Faryal Rizvi
- Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Mark R Korst
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Muhammad Hamza Habib
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Joshua A Kra
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
| | - Ankit Shah
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
| | - Tina M Mayer
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Biren Saraiya
- Department of Medicine, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Olga F Jarrín
- School of Nursing, Rutgers, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA.
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Thabet C, Wheatley-Price P, Moore S. Medical Assistance in Dying in Patients With Cancer. JCO Oncol Pract 2023; 19:819-827. [PMID: 37582243 DOI: 10.1200/op.22.00615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Medical assistance in dying (MAiD) was legalized in Canada in 2016. To date, patients with cancer account for 69% of MAiD deaths, yet little information is available about these patients. We reviewed disease and treatment characteristics of patients with cancer who underwent MAiD to better understand this population and identify gaps in our current system of care. MATERIALS AND METHODS Patients with cancer who underwent MAiD through the Champlain Regional MAiD Network from June 2016 to November 2020 were reviewed. Baseline demographic, diagnostic, and treatment details were collected by retrospective review. RESULTS During the study period, 255 patients with cancer underwent MAiD. At the time of MAiD, 201 patients (79%) had metastatic disease. Most prevalent solid organ tumors were gastrointestinal (30%), lung (18%) and genitourinary (14%). MAiD was primarily provided in the home (48%) or an acute inpatient facility (40%). One hundred eighty-nine (74%) patients were evaluated by medical oncology, 23 by gynecology oncology (9%), 11 by hematology oncology (4%), and 177 (69%) by radiation oncology. One hundred fifty-eight (62%) patients were not seen by oncology specialists in the 30 days prior to MAiD. One hundred fifty-nine patients (62%) had at least one line of systemic therapy, 138 patients (54%) received radiotherapy, and 61 patients (24%) did not receive cancer-directed treatment. Palliative care assessed at least 213 patients (84%). Common reasons for pursuing MaiD included disease-related symptoms (33%), fear of future suffering or disability (19%), and the ability to control the time and manner of death (17%). In 36% of cases, the reason was not documented. CONCLUSION Although formal oncology consultation is not required before MAiD, with an ever-increasing number of novel cancer therapies, oncologists, cancer centers, and MAiD providers should consider collaborating to ensure a streamlined assessment process for patients.
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Affiliation(s)
- Chloe Thabet
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Wheatley-Price
- Department of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute Ottawa, Ontario, Canada
| | - Sara Moore
- Department of Medical Oncology, University of Ottawa, Ottawa, Ontario, Canada
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W DeClue R, Fisher MD, Gooden K, Walker MS, Le TK. Real-world outcomes in metastatic HR+/HER2-, HER2+ and triple negative breast cancer after start of first-line therapy. Future Oncol 2023; 19:909-923. [PMID: 37191097 DOI: 10.2217/fon-2022-0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Aim: We evaluated outcomes of first-line (1L) treatment of metastatic breast cancer by biomarker subtype in the community setting over the last decade. Methods: Eligible patients (n = 1518) were female, ≥18 years, diagnosed with metastatic breast cancer 2010 or later, had documented HR+/HER2-, HER2+, or triple negative breast cancer (TNBC); and initiated 1L therapy. Kaplan-Meier and Cox methods were used to evaluate 1L real-world progression-free survival and overall survival from start of 1L. Results: TNBC was diagnosed at an earlier stage and had higher tumor grade at initial diagnosis. 1L real-world progression-free survival and overall survival from start of 1L were shorter for TNBC than HR+/HER2- or HER2+. Conclusion: Overall prognosis for patients with metastatic TNBC remains poor, and new therapies are needed to improve clinical outcomes.
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Affiliation(s)
| | - Maxine D Fisher
- ConcertAI, 1120 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Kyna Gooden
- Bristol-Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
| | - Mark S Walker
- ConcertAI, 1120 Massachusetts Ave., Cambridge, MA 02138, USA
| | - Trong Kim Le
- Bristol-Myers Squibb, 3401 Princeton Pike, Lawrenceville, NJ 08648, USA
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Iocolano M, Langi A, Dharmarajan KV, Jones J. Palliative Care Delivery Systems and Integration With Palliative Care Teams. Semin Radiat Oncol 2023; 33:211-217. [PMID: 36990638 PMCID: PMC10107680 DOI: 10.1016/j.semradonc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Radiotherapy (RT) plays a critical role in the palliation of symptoms in patients with advanced or metastatic cancer. To address the growing need for these services, multiple dedicated palliative RT programs have been established. This article serves to highlight the novel ways in which palliative RT delivery systems support patients with advanced cancer. Through early integration of multidisciplinary palliative supportive services, rapid access programs facilitate best practices for oncologic patients at the end of life.
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Affiliation(s)
- Michelle Iocolano
- Resident Physician, Radiation Oncology, Philadelphia, PA , USA; Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Alyssa Langi
- Hospice and Palliative Care, Radiation Oncology, Philadelphia, PA , USA; Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA USA
| | - Kavita V Dharmarajan
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Jones
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA USA.
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Oertel M, Schmidt R, Steike DR, Eich HT, Lenz P. Palliative care on the radiation oncology ward-improvements in clinical care through interdisciplinary ward rounds. Strahlenther Onkol 2023; 199:251-257. [PMID: 35951037 PMCID: PMC9938032 DOI: 10.1007/s00066-022-01989-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/15/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Palliative care is essential for patients with terminal diseases and aims at effective symptom control. This may stand in opposition to radiation treatment as an oncological treatment modality. The hereby presented work demonstrates the successful integration of a palliative care service in the radiation oncology ward. METHODS Since 2015, 1018 patients were seen by the palliative care service on the radiation oncology ward and have been analyzed in this single center study. To assess teaching efficacy of the consultation service, a survey was conducted among 15 radiation oncology residents. RESULTS Cooperation between the two departments proved to be efficient with rising patient numbers. Palliative care was able to guide appropriate postdischarge care with the number of patients dying on the radiation oncology ward decreasing significantly (p = 0.009). The main topics for consultation were pain medication (92.3%), organization of postdischarge care (92.3%), and psycho-oncological support (84.6%). Most residents had a positive image of the palliative care service and consented on adjectives like "enriching", "empathic", "collegial", "professionally founded", and a "low threshold for consultation". All participants agreed that cooperation deepened their knowledge on palliative care. CONCLUSION A synergistic cooperation between a palliative care consultation service and a radiation oncology department addresses patient symptoms on an individual level. It confers advanced knowledge on palliative care which is essential for resident education and patient treatment.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.
| | - Renate Schmidt
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - David Rene Steike
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany
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12
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Dennis K, Linden K, Gaudet M. A shift from simple to sophisticated: using intensity-modulated radiation therapy in conventional nonstereotactic palliative radiotherapy. Curr Opin Support Palliat Care 2023; 17:70-76. [PMID: 36695868 DOI: 10.1097/spc.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW The authors aimed to highlight trends in, and evidence underlying the use of highly conformal radiotherapy (RT) techniques in conventional nonstereotactic palliative RT. The authors reviewed palliative-intent and curative-intent studies relevant to the use of intensity-modulated radiation therapy (IMRT) for the delivery of nonstereotactic conventional regimens to the brain, head and neck, thorax, abdomen and pelvis, and bone metastases. RECENT FINDINGS The use of IMRT has become standard with certain indications for brain metastases such as hippocampus-avoiding/limiting whole brain RT. IMRT in the treatment of bone metastases is increasing at many institutions despite limited data comparing its effectiveness with that of fluoroscopy-based and three-dimensional conformal radiation therapy techniques. There is scant data describing the use of IMRT for palliation in other extracranial anatomic sites; guidance for its use in these settings must be gleaned almost exclusively from curative-intent randomized trials, consensus recommendations and contouring atlases. SUMMARY Consistent with historical technology shifts in RT practice, the uptake of highly conformal techniques such as IMRT for conventional palliative RT will likely outpace rigorous evaluations of their advantages and disadvantages relative to simpler techniques. Opportunities exist in virtually all anatomic sites for observational and randomized studies to evaluate the clinical impacts of these modern techniques in the palliative setting.
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Affiliation(s)
- Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa
| | - Kelly Linden
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa
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Safety and Feasibility of Radiation Therapy Combined with CDK 4/6 Inhibitors in the Management of Advanced Breast Cancer. Cancers (Basel) 2023; 15:cancers15030690. [PMID: 36765648 PMCID: PMC9913652 DOI: 10.3390/cancers15030690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
The addition of CDK4/6 inhibitors to endocrine therapy in advanced hormone receptor-positive HER2-negative breast cancer has led to practice-changing improvements in overall survival. However, data concerning the safety of CDK4/6i combination with radiotherapy (RT) are conflicting. A retrospective evaluation of 288 advanced breast cancer patients (pts) treated with CDK4/6i was performed, and 100 pts also received RT. Forty-six pts received 63 RT courses concurrently and fifty-four sequentially before CDK4/6i initiation (76 RT courses). Neutropenia was common (79%) and more frequent during and after concurrent RT than sequential RT (86% vs. 76%); however, CDK4/6i dose reduction rates were similar. In patients treated with CDK4/6i alone, the dose reduction rate was 42% (79 pts) versus 38% with combined therapy, and 5% discontinued treatment due to toxicity in the combined group. The risk of CDK4/6i dose reduction was correlated with neutropenia grade, RT performed within the first two CDK4/6i cycles, and more than one concurrent RT; a tendency was observed in concurrent bone irradiation. However, on multivariate regression analysis, only ECOG 1 performance status and severe neutropenia at the beginning of the second cycle were found to be associated with a higher risk of CDK4/6i dose reduction. This largest single-center experience published to date confirmed the acceptable safety profile of the CDK4/6i and RT combination without a significantly increased toxicity compared with CDK4/6i alone. However, one might delay RT for the first two CDK4/6i cycles, when myelotoxic AE are most common.
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14
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Hoeltgen L, Meixner E, Hoegen P, Sandrini E, Weykamp F, Forster T, Vinsensia M, Lang K, König L, Arians N, Fremd C, Michel LL, Smetanay K, Schneeweiss A, Wallwiener M, Debus J, Hörner-Rieber J. Palliative Radiotherapy for Symptomatic Locally Advanced Breast Cancer. Technol Cancer Res Treat 2023; 22:15330338231164537. [PMID: 37038619 PMCID: PMC10103240 DOI: 10.1177/15330338231164537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Objective: Women with locally advanced breast cancer (LABC) or inoperable local recurrence often suffer from a significantly reduced quality of life (QOL) due to local tumor-associated pain, bleeding, exulceration, or malodorous discharge. We aimed to further investigate the benefit of radiotherapy (RT) for symptom relief while weighing the side-effects. Materials and methods: Patients who received symptom-oriented RT for palliative therapy of their LABC or local recurrence in the Department of Radiation Oncology at Heidelberg University Hospital between 2012 and 2021 were recorded. Clinical, pathological, and therapeutic data were collected and the oncological and symptomatic responses as well as therapy-associated toxicities were analyzed. Results: We retrospectively identified 26 consecutive women who received palliative RT with a median total dose of 39 Gy or single dose of 3 Gy in 13 fractions due to (impending) exulceration, pain, local hemorrhage, and/or vascular or plexus compression. With a median follow-up of 6.5 months after initiation of RT, overall survival at 6 and 12 months was 60.0% and 31.7%, and local control was 75.0% and 47.6%, respectively. Radiation had to be discontinued in 4 patients due to oncological clinical deterioration or death. When completed as initially planned, symptom improvement was achieved in 95% and WHO level reduction of analgesics in 28.6% of patients. In 36% (16%) of patients, local RT had already been indicated >3 months (>6 months) before the actual start of RT, but was delayed or not initiated among others in favor of drug alternatives or systemic therapies. RT-associated toxicities included only low-grade side-effects (CTCAE I°-II°) with predominantly skin erythema and fatigue even in the context of re-RT. Conclusion: Palliative RT in symptomatic LABC or locoregional recurrence is an effective treatment option for controlling local symptoms with only mild toxicity. It may thus improve QOL and should be considered early in palliative patient care management.
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Affiliation(s)
- Line Hoeltgen
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabetta Sandrini
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Forster
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Maria Vinsensia
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Nathalie Arians
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Carlo Fremd
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Laura L Michel
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Katharina Smetanay
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Department of Gynecology and Obstetrics, 27178Heidelberg University Hospital, Heidelberg, Germany
| | | | - Markus Wallwiener
- Department of Gynecology and Obstetrics, 27178Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion Beam Therapy Center (HIT), Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, 27178Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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15
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Chen JJ, Roldan CS, Nichipor AN, Balboni TA, Krishnan MS, Revette AC, Chen AB, Hertan LM. Prognostic Understanding and Goals of Palliative Radiotherapy: A Qualitative Study. J Pain Symptom Manage 2022; 64:567-576. [PMID: 36007684 DOI: 10.1016/j.jpainsymman.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT There is a paucity of data describing patients' expectations of goals of palliative radiotherapy (RT) and overall prognosis. OBJECTIVES To explore patients' perceptions of and preferences for communication surrounding goals of palliative RT and cancer prognosis. METHODS We conducted a qualitative study utilizing semi-structured interviews with seventeen patients with either bone or lung metastases receiving their first course of palliative RT at a comprehensive cancer center. All patient interviews were recorded, transcribed verbatim, and thematically analyzed. RESULTS Themes of goals of palliative RT centered on either restoration, such as through improving quality of life or minimizing pain, or on a desire to combat cancer by eliminating tumor. While most patients perceived that palliative RT would palliate symptoms but not cure their cancer, some patients believed that the goal of palliative RT was to cure. Themes that emerged surrounding patients' understanding of prognosis and what lies ahead included uncertainty and apprehension about the future, a focus on additional treatment, and confronting mortality. Most patients preferred to receive information about goals of treatment and prognosis from their doctors, including radiation oncologists, rather than other members of the medical team. Patients also expressed a desire for written patient education materials on palliative RT. CONCLUSION Unclear perceptions of goals of treatment and prognosis may motivate some patients to pursue unnecessarily aggressive cancer treatments. Patients desire prognostic information from their doctors, including radiation oncologists, who are important contributors to goals of care discussions and may improve patient understanding and well-being by using restorative rather than combat-oriented language.
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Affiliation(s)
- Jie Jane Chen
- Department of Radiation Oncology (J.J.C.), University of San Francisco, San Francisco, California, USA
| | - Claudia S Roldan
- Northwestern Feinberg School of Medicine (C.S.R.), Chicago, Illinois, USA
| | - Alexandra N Nichipor
- Psychosocial Oncology and Palliative Care (A.N.N.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tracy A Balboni
- Department of Radiation Oncology (T.A.B., M.S.K.), Dana-Farber Cancer Institute/ Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Monica S Krishnan
- Department of Radiation Oncology (T.A.B., M.S.K.), Dana-Farber Cancer Institute/ Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Anna C Revette
- Survey and Data Management Core (A.C.R.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Aileen B Chen
- Department of Radiation Oncology (A.B.C.), MD Anderson Cancer Center, Houston, Texas, USA
| | - Lauren M Hertan
- Department of Radiation Oncology (L.M.H.), Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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16
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Jooya A, Talla K, Wei R, Huang F, Dennis K, Gaudet M. Systematic review of brachytherapy for symptom palliation. Brachytherapy 2022; 21:912-932. [PMID: 36085137 DOI: 10.1016/j.brachy.2022.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Brachytherapy is most often applied in the curative or salvage setting, but many forms of brachytherapy can be helpful for symptom palliation. Declining utilization is seen, for multiple reasons, such as lack of awareness, insufficient expertise, or poor access to equipment. High level evidence for many types of palliative brachytherapy has been lacking. The objective of the current study was to review the evidence for utilization and efficacy of brachytherapy to palliate symptoms from cancer. MATERIALS AND METHODS We performed a systematic search in EMBASE and MEDLINE for English-language articles published from January 1980 to May 2022 that described brachytherapy used for a palliative indication in adults with a diagnosis of cancer (any subtype) and at least one symptom related outcome. Individual case reports and conference abstracts were excluded. All publications were independently screened by two investigators for eligibility. RESULTS The initial search identified 3637 abstracts of which 129 were selected for in-depth review. The number of studies (total number of patients) included in the final analysis varied widely by tumor site with the majority (68.2%) involving either lung or esophageal cancer. Despite a limited number of prospective trials that assessed the efficacy of brachytherapy for symptom management, there was a positive effect on palliation of symptoms across all tumor types. There was no clear trend in the number of publications over time. The most commonly cited symptom indications for palliation by brachytherapy were dysphagia, dyspnea, pain and bleeding. CONCLUSIONS Brachytherapy can provide palliation for patients with advanced cancer, across different tumor sites and clinical scenarios. However, high level evidence in the literature to support palliative applications of brachytherapy is lacking or limited for many tumor sites. There appears to be a strong publication bias towards positive studies in favor of brachytherapy. Beyond anecdotal reports and individual practices, outcomes research can further our understanding of the role of brachytherapy in palliating advanced cancers of all types, and should be encouraged.
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Affiliation(s)
- Alborz Jooya
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Kota Talla
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Randy Wei
- Memorial Radiation Oncology Medical Group, Long Beach, CA
| | - Fleur Huang
- Division of Radiation Oncology, Cross Cancer Institute and University of Alberta, Edmonton, AB, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.
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17
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Mackenzie P, Vajdic C, Delaney G, Comans T, Morris L, Agar M, Gabriel G, Barton M. Radiotherapy utilisation rates for patients with cancer as a function of age: A systematic review. J Geriatr Oncol 2022; 14:101387. [PMID: 36272958 DOI: 10.1016/j.jgo.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION There is an increasing incidence of cancer in older people, but limited data on radiotherapy uptake, and in particular, radiotherapy utilisation (RTU) rates. The RTU rate for older adults with cancer may be lower than recommended due to lower tolerance for radiotherapy as well as additional comorbidities, reduced life expectancy and travel for treatment. Radiotherapy use must be aligned with best available, age-specific evidence to ensure older adults with cancer receive optimal benefit without harms. MATERIALS AND METHODS A systematic review was conducted to synthesise the published data on the actual RTU rate for patients with cancer as a function of age. MEDLINE and EMBASE were systematically searched to identify relevant population-based and hospital-based cohort studies on radiotherapy utilisation for all age groups, published in English, from 1 January 1990 to 1 July 2020. We focused on the following common cancers in older adults for which radiotherapy is recommended: breast, prostate, lung, rectal cancer, glioblastoma multiforme (GBM), and cervical cancer. Age-specific radiotherapy utilisation data were extracted and analysed as a narrative synthesis. RESULTS From 2606 studies screened, 75 cohort and population-based studies were identified with age-specific radiotherapy utilisation data. The total number of patients in the 75 studies was 4,792,138. The RTU rate decreased with increasing age for all tumour sites analysed, except for patients receiving curative radiotherapy as definitive treatment for prostate or cervical cancer. This reduction with increasing age was demonstrated in both palliative and curative settings. DISCUSSION There is a global reduction in radiotherapy utilisation with increasing age for most tumour sites. The reduction in delivery of radiotherapy warrants further examination and evidence-based guidelines specific to this population.
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18
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Fabian A, Domschikowski J, Letsch A, Schmalz C, Freitag-Wolf S, Dunst J, Krug D. Clinical endpoints in trials of palliative radiotherapy: A systematic meta-research analysis. Radiother Oncol 2022; 174:123-131. [PMID: 35868602 DOI: 10.1016/j.radonc.2022.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Up to 50% of radiotherapy courses are delivered in palliative intent for various indications. Despite the large number of treated patients, we know little about the choice of endpoints in trials of palliative radiotherapy. Our primary aim was, therefore, to analyze primary endpoints in trials of palliative radiotherapy. METHODS We conducted a pre-registered (https://doi.org/10.17605/OSF.IO/GMCAF) meta-research analysis searching Pubmed/MEDLINE, EMBASE, CENTRAL, and "ClinicalTrials.gov" for clinical trials of palliative radiotherapy published 1990-2020. Endpoints were categorized in "patient-centered endpoints", including overall survival and patient-reported outcomes, and "tumor-centered endpoints" such as local control. The remainder were "other endpoints" including toxicity or observer-rated symptoms. We applied descriptive statistics to summarize data and logistic regression to assess if year of publication predicted the choice of primary endpoints. RESULTS Of 7379 records screened, 292 were eligible. Trials were characterized by small sample sizes and use of external beam radiotherapy for metastases or thoracic primaries. Median patient age was 64 and median ECOG was 1. Only 64.4%(145/225) of published trials clearly stated their primary endpoint. Published trials employed a "patient-centered primary endpoint" in 45.5%(66/145) and a "tumor-centered primary endpoint" in 17.3%(25/145) of the cases. There was no statistically significant trend in time for the use of "patient-centered primary endpoints". Registered ongoing trials used a "patient-centered primary endpoint" in 32.8%(22/67) and a "tumor-centered primary endpoint" in 26.9%(18/67) of the cases. CONCLUSION Although "patient-centered primary endpoints" appear relatively prevalent in published trials of palliative radiotherapy, their use is still suboptimal and appears to be lower in currently ongoing trials.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Anne Letsch
- Department of Hematology and Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, 24118 Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
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19
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Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: a meta-analysis. Radiother Oncol 2022; 168:147-210. [DOI: 10.1016/j.radonc.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
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20
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Erfani P, Figueroa JF, Lam MB. Reforms to the Radiation Oncology Model: Prioritizing Health Equity. Int J Radiat Oncol Biol Phys 2021; 110:328-330. [PMID: 33989572 DOI: 10.1016/j.ijrobp.2021.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
| | - Jose F Figueroa
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Miranda B Lam
- Department of Health Policy & Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Boston, Massachusetts.
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21
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Luh JY. Radiation Oncology Alternative Payment Model's Impact on Small and Rural Practices. JCO Oncol Pract 2021; 17:765-769. [PMID: 34406819 DOI: 10.1200/op.21.00286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Join Y Luh
- Providence Health, St Joseph Hospital, Eureka, CA
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22
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Quiñones-Avila V, Ortiz-Ortiz KJ, Ríos-Motta R, Marín-Centeno H, Tortolero-Luna G. Use of palliative radiotherapy among patients with metastatic non-small-cell lung cancer in Puerto Rico. BMC Palliat Care 2021; 20:127. [PMID: 34389004 PMCID: PMC8364074 DOI: 10.1186/s12904-021-00819-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative radiotherapy (RT) represents an important treatment opportunity for improving the quality of life in metastatic non-small cell lung cancer (NSCLC) patients through the management of symptoms within the course of the illness. The aim of the study is to determine the proportion of patients who had palliative RT within 12 months of diagnosis and evaluate the factors associated with it. METHODS A retrospective cohort study was performed using secondary data analysis from 2009 to 2015 from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). A logistic regression model was used to examine factors associated with palliative RT. RESULTS Among the 929 patients identified with metastatic NSCLC, 33.80% received palliative RT within the first year after diagnosis. After adjusting for other covariates, receipt of chemotherapy (ORAdj = 3.90; 95% CI = 2.91-5.45; P < 0.001) and presence of symptoms (ORAdj = 1.41; 95% CI =1.00-1.98; P = 0.045) were associated with increased odds of palliative RT use. Although marginally significant, patients with private health insurance had increased odds of palliative RT use (ORAdj = 1.50; 95% CI = 0.98-2.29; P = 0.061) when compared to beneficiaries of Medicaid, after adjusting by other covariates. CONCLUSIONS The results of this study reveal concerning underuse of palliative RT among patients with metastatic NSCLC in Puerto Rico. Additional research is necessary to further understand the barriers to using palliative RT on the island.
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Affiliation(s)
- Valerie Quiñones-Avila
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Karen J Ortiz-Ortiz
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico. .,Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico. .,Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico.
| | - Ruth Ríos-Motta
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Heriberto Marín-Centeno
- Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 363027, San Juan, 00936-3027, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
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Williams GR, Manjunath SH, Butala AA, Jones JA. Palliative Radiotherapy for Advanced Cancers: Indications and Outcomes. Surg Oncol Clin N Am 2021; 30:563-580. [PMID: 34053669 DOI: 10.1016/j.soc.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Palliative radiotherapy (PRT) is well-tolerated, effective treatment for pain, bleeding, obstruction, and other symptoms/complications of advanced cancer. It is an important component of multidisciplinary management. It should be considered even for patients with poor prognosis, because it can offer rapid symptomatic relief. Furthermore, expanding indications for treatment of noncurable disease have shown that PRT can extend survival for select patients. For those with good prognosis, advanced PRT techniques may improve the therapeutic ratio, maximizing tumor control while limiting toxicity. PRT referral should be considered for any patient with symptomatic or asymptomatic sites of disease where local control is desired.
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Affiliation(s)
- Graeme R Williams
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA; Leonard Davis Institute of Healthcare Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Shwetha H Manjunath
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - Anish A Butala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
| | - Joshua A Jones
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Boulevard, 2nd Floor West, Philadelphia, PA 19104, USA
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Chang EM, Walling AM, Raldow AC, Lee PP, Martin EJ. Radiation Oncology Program Directors' Attitudes Toward Twenty-Seven Discrete Palliative Care Skills. J Palliat Med 2021; 25:39-45. [PMID: 34191605 DOI: 10.1089/jpm.2021.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: We evaluated radiation oncology residency program directors' attitudes toward discrete palliative care skills in effort to determine which skills should be prioritized in radiation oncology resident training. Design: We identified 93 U.S. radiation oncology residency program directors and sent them a survey through e-mail. The survey assessed views of 27 discrete palliative care skills in eight domains and was adapted from the American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement defining high-quality primary palliative care in medical oncology. Using a nine-point scale, respondents rated each skill on three constructs: (1) importance to high-quality cancer care, (2) relevance of the skill to radiation oncology practice, and (3) importance to radiation oncology residency education. Skills were categorized as "Include" (median score ≥7 for all constructs), "Exclude" (median score ≤3 for all constructs), or "Uncertain" (all other skills) using a composite score of all constructs. Results: Twenty-nine program directors (response rate 31%) completed the survey. Of the 27 skills, 100% were rated as highly important to high-quality cancer care, 70% were rated as highly relevant to radiation oncology practice, and 81% were rated as highly important to resident education (median score ≥7). Using the composite score, 70% of skills were categorized as "Include." The domains of Caregiver Support (100%), End-of-Life Care (66%), and Spiritual/Cultural Assessment and Management (33%) had the highest proportions of skills rated as "Uncertain." Conclusions: The surveyed radiation oncology residency program directors generally value palliative care skills within radiation oncology.
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Affiliation(s)
- Eric M Chang
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Anne M Walling
- Department of Medicine and University of California, Los Angeles, Los Angeles, California, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ann C Raldow
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA
| | - Percy P Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Emily J Martin
- Department of Medicine and University of California, Los Angeles, Los Angeles, California, USA
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Dharmarajan KV, Presley CJ, Wyld L. Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives. Am Soc Clin Oncol Educ Book 2021; 41:1-10. [PMID: 33956492 DOI: 10.1200/edbk_319841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Older adults comprise a considerable proportion of patients with cancer in the world. Across multiple cancer types, cancer treatment outcomes among older age groups are often inferior to those among younger adults. Cancer care for older individuals is complicated by the need to adapt treatment to baseline health, fitness, and frailty, all of which vary widely within this age group. Rates of social deprivation and socioeconomic disparities are also higher in older adults, with many living on reduced incomes, further compounding health inequality. It is important to recognize and avoid undertreatment and overtreatment of cancer in this age group; however, simply addressing this problem by mandating standard treatment of all would lead to harms resulting from treatment toxicity and futility. However, there is little high-quality evidence on which to base these decisions, because older adults are poorly represented in clinical trials. Clinicians must recognize that simple extrapolation of outcomes from younger age cohorts may not be appropriate because of variance in disease stage and biology, variation in fitness and treatment tolerance, and reduced life expectancy. Older patients may also have different life goals and priorities, with a greater focus on quality of life and less on length of life at any cost. Health care professionals struggle with treatment of older adults with cancer, with high rates of variability in practice between and within countries. This suggests that better national and international recommendations that more fully address the needs of this special patient population are required and that primary research focused on the older age group is urgently required to inform these guidelines.
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Affiliation(s)
- Kavita V Dharmarajan
- Department of Radiation Oncology, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, James Cancer Hospital & Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, United Kingdom.,Doncaster and Bassetlaw Teaching Hospitals, National Health Service Foundation Trust, Doncaster, United Kingdom
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Hong D, Das LC, Daily E, Levine SK, Hahn OM, Liauw SL, Golden DW, Son CH. Goals of care discussions: perceptions of radiation and medical oncologists. Support Care Cancer 2021; 29:7279-7288. [PMID: 34031753 DOI: 10.1007/s00520-021-06258-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/28/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Goals of care discussions (GOCD) are essential when counseling patients with cancer. Respective roles of radiation oncologists (RO) and medical oncologists (MO) in GOCD can be unclear. This study aims to clarify the dynamics and barriers to GOCD. METHODS Five hundred and fifty-four ROs and 1604 MOs at NCI-designated comprehensive cancer centers were sent an anonymous electronic survey regarding demographics, opinions, training in GOCD, GOCD frequency, and three vignettes. Response formats were Yes/No, Likert-type, and free response. Chi-square and Wilcoxon rank-sum tests were performed. Likert-type scores were reported as median [interquartile range]. RESULTS There were 76 (13.7%) RO and 153 (9.5%) MO who completed surveys. Sixty-three percent of RO and 66% of MO reported GOCD with > 50% of patients (p = 0.90). GOCD were initiated for declining performance status (74%) and poor life expectancy (69%). More MO (42%) received formal GOCD training compared to RO (18%) (p < 0.01). MO were more comfortable conducting GOCD than RO (p < 0.01). RO-conducted GOCD were rated to be less important by MO compared to RO (p < 0.05). Thirty-six percent of MO reported being "not at all" or "somewhat" comfortable with RO-conducted GOCD. RO-initiated GOCD with new patients were rated less appropriate by RO compared to MO perceptions of RO-initiated GOCD (p < 0.01). CONCLUSIONS While MO and RO conduct GOCD with similar frequency, MO are more comfortable conducting GOCD and are more likely to have formal training. MO rate importance of RO involvement lower than RO. Further research is needed to understand interdisciplinary dynamics that may impact GOCD and subsequent patient care outcomes.
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Affiliation(s)
- Daniel Hong
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Ellen Daily
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Stacie K Levine
- Department of Medicine, Section of Geriatrics and Palliative Medicine, The University of Chicago, Chicago, IL, USA
| | - Olwen M Hahn
- Department of Medicine, Section of Hematology-Oncology, The University of Chicago, Chicago, IL, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA
| | - Daniel W Golden
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA
| | - Christina H Son
- Department of Radiation and Cellular Oncology, The University of Chicago, 5758 S. Maryland Ave MC 9006, Chicago, IL, 60637, USA.
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Vargas A. Is Performance Status Enough to Decide the Palliative Radiotherapy Schedule in Lung Cancer? Clin Oncol (R Coll Radiol) 2021; 33:e463. [PMID: 33966949 DOI: 10.1016/j.clon.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 01/16/2023]
Affiliation(s)
- A Vargas
- Radiation Oncology Department, Clínica Instituto de Radiomedicina (IRAM), Santiago, Chile
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Vázquez M, Altabas M, Moreno DC, Geng AA, Pérez-Hoyos S, Giralt J. 30-Day Mortality Following Palliative Radiotherapy. Front Oncol 2021; 11:668481. [PMID: 33968775 PMCID: PMC8103895 DOI: 10.3389/fonc.2021.668481] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/19/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose 30-day mortality (30-DM) is a parameter with widespread use as an indicator of avoidance of harm used in medicine. Our objective is to determine the 30-DM followed by palliative radiation therapy (RT) in our department and to identify potential prognosis factors. Material/Methods We conducted a retrospective cohort study including patients treated with palliative RT in our center during 2018 and 2019. Data related to clinical and treatment characteristics were collected. Results We treated 708 patients to whom 992 palliative irradiations were delivered. The most frequent primary tumor sites were lung (31%), breast (14.8%), and gastrointestinal (14.8%). Bone was the predominant location of the treatment (56%), and the use of single doses was the preferred treatment schedule (34.4%). The 30-DM was 17.5%. For those who died in the first month the median survival was 17 days. Factors with a significant impact on 30-DM were: male gender (p < 0.0001); Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) of 2–3 (p = 0.0001); visceral metastases (p = 0.0353); lung, gastrointestinal or urinary tract primary tumors (p = 0.016); and single dose RT (p = <0.0001). In the multivariate analysis, male gender, ECOG PS 2–3, gastrointestinal and lung cancer were found to be independent factors related to 30-DM. Conclusion Our 30-DM is similar to previous studies. We have found four clinical factors related to 30-DM of which ECOG was the most strongly associated. This data may help to identify terminally ill patients with poor prognosis in order to avoid unnecessary treatments.
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Affiliation(s)
- Miriam Vázquez
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Manuel Altabas
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Diana C Moreno
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Abraham A Geng
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Santiago Pérez-Hoyos
- Unit of Statistics and Bioinformatics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Jordi Giralt
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain
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Actual Versus Optimal Radiotherapy Utilisation for Metastatic Cancer Patients in the 45 and Up Study Cohort, New South Wales. Clin Oncol (R Coll Radiol) 2021; 33:650-660. [PMID: 33750600 DOI: 10.1016/j.clon.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
AIMS Radiotherapy can provide quality of life and/or survival benefits to patients with metastatic cancer on diagnosis (MCOD). However, little is known about radiotherapy utilisation in this population. We compared the optimal radiotherapy rates with actual uptake for people who present with MCOD in the 45 and Up Study cohort, and examined factors associated with utilisation. MATERIALS AND METHODS In total, 267 153 individuals aged ≥45 enrolled in the Sax Institute's 45 and Up Study completed a baseline questionnaire during 2006-2009, providing sociodemographic and health information and consent for linkage to administrative health databases. Participants diagnosed up to December 2013 with MCOD were identified in the New South Wales Cancer Registry. Radiotherapy receipt was determined from claims to the Medicare Benefits Schedule and/or records in the New South Wales Admitted Patient Data Collection (2006 to June 2016). The Collaboration for Cancer Outcomes, Research and Evaluation optimal utilisation model was adapted for patients with MCOD to provide a benchmark. RESULTS Of 17 687 participants diagnosed with cancer after completion of the baseline questionnaire, 2392 had MCOD. Of patients with MCOD, 25% had primary lung cancer, which was the most common site. The actual radiotherapy utilisation rate for all patients was 32.3%, lower than the optimal of 45.0%. From multivariable analysis, patients who were aged ≥80 years and/or needed help with daily tasks and/or had a Charlson Comorbidity Index ≥2 were less likely to receive radiotherapy. CONCLUSIONS Actual uptake of radiotherapy was below optimal. Elderly patients and/or those with more comorbidities were less likely to receive radiotherapy. These results suggest a potential role for advocacy and education around radiotherapy for these patient groups.
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Barton M, Batumalai V, Spencer K. Health Economic and Health Service Issues of Palliative Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:775-780. [DOI: 10.1016/j.clon.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
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Dennis K, Harris G, Kamel R, Barnes T, Balboni T, Fenton P, Rembielak A. Rapid Access Palliative Radiotherapy Programmes. Clin Oncol (R Coll Radiol) 2020; 32:704-712. [DOI: 10.1016/j.clon.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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Ghiassi-Nejad Z, Sindhu KK, Moshier E, Zubizarreta N, Mazumdar M, Goldstein NE, Dharmarajan KV. Factors associated with the receipt and completion of whole brain radiation therapy among older adults in the United States from 2010-2013. J Geriatr Oncol 2020; 11:1096-1102. [PMID: 32245729 DOI: 10.1016/j.jgo.2020.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/25/2019] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Whole brain radiation therapy (WBRT) is widely used to treat patients with brain metastases. However, there is debate regarding its utility in patients with poor prognoses. In this study, we sought to characterize the use of WBRT in the United States, especially in adults aged 55 and above. MATERIAL AND METHODS Patients with brain metastases were identified using the National Cancer Database between 2010 and 2013. The receipt and completion of WBRT with various patient factors were correlated using multivariable logistic regression. RESULTS 28,422 patients with brain metastases were identified, 23,362 of whom were aged 55 or above. 14,845 patients received WBRT and 12,310 patients completed treatment. Among adults aged 55 and above, 11,945 patients received WBRT, and 9812 patients completed treatment. Patients aged 60 and above were less likely to receive WBRT, while those aged 65 and above were less likely to complete WBRT. DISCUSSION These results suggest that WBRT may be over-utilized in the United States, especially among older adults. Better interventions to improve pre-WBRT decision-making in this population are needed to select patients who might derive benefit.
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Affiliation(s)
- Zahra Ghiassi-Nejad
- Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, USA
| | - Kunal K Sindhu
- Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, USA
| | - Erin Moshier
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue (Box 1077), New York, NY 10029, USA
| | - Nicole Zubizarreta
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue (Box 1077), New York, NY 10029, USA
| | - Madhu Mazumdar
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue (Box 1077), New York, NY 10029, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
| | - Kavita V Dharmarajan
- Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1184 Fifth Avenue, New York, NY 10029, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA.
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Benson KR, Aggarwal S, Carter JN, von Eyben R, Pradhan P, Prionas ND, Bui JL, Soltys SG, Hancock S, Gensheimer MF, Koong AC, Chang DT. Predicting Survival for Patients With Metastatic Disease. Int J Radiat Oncol Biol Phys 2020; 106:52-60. [DOI: 10.1016/j.ijrobp.2019.10.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/10/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
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Hirvonen OM, Leskelä RL, Grönholm L, Haltia O, Rissanen A, Tyynelä-Korhonen K, Rahko EK, Lehto JT, Saarto T. Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study. Acta Oncol 2019; 58:1699-1705. [PMID: 31742490 DOI: 10.1080/0284186x.2019.1659512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life.Material and methods: Patients with a cancer diagnosis treated in tertiary hospital during 1st January 2013 - 31st December 2014 and deceased by the end of 2014 were identified in the hospital database (N = 2737). Of these patients, 992 were randomly selected for this study. The PC decision was screened from patient records, i.e., termination of cancer-specific treatments and a focus on symptom-centered PC.Results: The PC decision was defined in 82% of the patients during the last year of life (49% >30 days and 33% ≤30 days before death, 18% with no decision). The median time from the decision to death was 46 days. Systemic cancer therapy was given during the last month of life in 1%, 36% and 38% (p < .001) and radiotherapy 22%, 40% and 31% (p = .03) cases, respectively; referral to a PC unit was made in 62%, 22% and 11%, respectively (p < .001). In logistic regression analyses younger age, shorter duration of the disease trajectory and type of cancer (e.g., breast cancer) were associated with a lack or late timing of the PC decision.Conclusion: The decision to initiate a palliative goal for the treatment was frequently made for cancer patients but occurred late for every third patient. Younger age and certain cancer types were associated with late PC decisions, thus leading to anti-cancer treatments continuing until close to the death with low access to a PC unit.
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Affiliation(s)
- Outi M. Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | | | - Lotta Grönholm
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Olli Haltia
- Tuusula Health Care Centre, Tuusula, Finland
| | | | | | - Eeva K. Rahko
- Department of Clinical Oncology, Oulu University Hospital, Oulu, Finland
| | - Juho T. Lehto
- Department of Oncology, Palliative Care Unit, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
- Department of Palliative Care, Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
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Banham D, Roder D, Eckert M, Howard NJ, Canuto K, Brown A. Cancer treatment and the risk of cancer death among Aboriginal and non-Aboriginal South Australians: analysis of a matched cohort study. BMC Health Serv Res 2019; 19:771. [PMID: 31665005 PMCID: PMC6820943 DOI: 10.1186/s12913-019-4534-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander Australians have poorer cancer outcomes than other Australians. Comparatively little is known of the type and amount of cancer treatment provided to Aboriginal and Torres Strait Islander people and the consequences for cancer survival. This study quantifies the influence of surgical, systemic and radiotherapy treatment on risk of cancer death among matched cohorts of cancer cases and, the comparative exposure of cohorts to these treatments. METHODS Cancers registered among Aboriginal South Australians in 1990-2010 (N = 777) were matched with randomly selected non-Indigenous cases by sex, birth and diagnostic year, and primary site, then linked to administrative cancer treatment for the period from 2 months before to 13 months after diagnosis. Competing risk regression summarised associations of Indigenous status, geographic remoteness, comorbidities, cancer stage and treatment exposure with risk of cancer death. RESULTS Fewer Aboriginal cases had localised disease at diagnosis (37.2% versus 50.2%) and they were less likely to: experience hospitalisation with cancer diagnosis, unadjusted odds ratio (UOR) = 0.76; 95%CI = 0.59-0.98; have surgery UOR = 0.65; 95%CI = 0.53-0.80; systemic therapies UOR = 0.64; 95%CI = 0.52-0.78; or radiotherapy, UOR = 0.76; 95%CI = 0.63-0.94. Localised disease carried lower risk of cancer death compared to advanced cases receiving surgery or systemic therapies, SHR = 0.34; 95%CI = 0.25-0.47 and SHR = 0.35; 95%CI = 0.25-0.48. Advanced disease and no treatment carried higher risk of cancer death, SHR = 1.82; 95%CI = 1.26-2.63. CONCLUSION The effects of treatment did not differ between Aboriginal and non-Indigenous cohorts. However, comparatively less exposure to surgical and systemic treatments among Aboriginal cancer cases further complicated the disadvantages associated with geographic remoteness, advanced stage of disease and co-morbid conditions at diagnosis and add to disparities in cancer death. System level responses to improving access, utilisation and quality of effective treatments are needed to improve survival after cancer diagnosis.
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Affiliation(s)
- David Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.
| | - David Roder
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia North Terrace, Adelaide, Australia
| | - Natasha J Howard
- School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Karla Canuto
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
- Aboriginal Health Research Group, Cancer Research Institute, University of South Australia, Adelaide, Australia
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Beckham TH, Leeman JE, Xie P, Li X, Goldman DA, Zhang Z, Sherman E, McBride S, Riaz N, Lee N, Tsai CJ. Long-term survival in patients with metastatic head and neck squamous cell carcinoma treated with metastasis-directed therapy. Br J Cancer 2019; 121:897-903. [PMID: 31649318 PMCID: PMC6888861 DOI: 10.1038/s41416-019-0601-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/08/2019] [Accepted: 09/27/2019] [Indexed: 01/05/2023] Open
Abstract
Background Our objective was to evaluate the outcomes of metastatic head and neck squamous cell carcinoma (HNSCC) by disease burden with an emphasis on metastasis-directed therapy (MDT) in patients with limited metastatic disease burden. Methods In total, 186 patients who developed metastatic disease after definitive therapy for HNSCC were included. Clinically and radiographically apparent metastases were enumerated. Kaplan–Meier methods were used to estimate survival. Cox regression was used to assess the association between clinical variables. Results Patients with a single metastasis had a 5-year overall survival (OS) of 35% (95% CI 16–54%) in contrast to patients with multiple metastases with a 5-year OS of 4% (95% CI 2–9%). Thirty patients (16.1%) underwent MDT. On multivariable analysis, oral cavity or sinonasal primary (HR 2.22 95% CI 1.16–4.25, p = 0.015; HR 4.88, 95% CI 1.10–21.70, p = 0.037, respectively) were associated with higher risk of death, whereas receipt of MDT (HR 0.36, 95% CI 0.17–0.74, p = 0.006) was associated with lower hazard of death. Median subsequent metastasis-free survival and 5-year survival after MDT (n = 30) were estimated at 26.4 months (95% CI: 9.8–54.0) and 31%, (95% CI: 15–48%). Conclusions HNSCC patients with limited metastatic disease may derive significant benefit from MDT. Prospective trials evaluating MDT in HNSCC are warranted.
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Affiliation(s)
- Thomas H Beckham
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peng Xie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaolin Li
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Linden K, Renaud J, Zohr R, Gaudet M, Haddad A, Pantarotto J, Dennis K. Clinical Specialist Radiation Therapist in Palliative Radiation Therapy: Report of an Orientation, Training, and Support Program. J Med Imaging Radiat Sci 2019; 50:543-550. [PMID: 31668680 DOI: 10.1016/j.jmir.2019.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION A clinical specialist radiation therapist (CSRT) position in palliative radiation therapy (RT) was created at our institution. Herein, we report the details of the CSRT's orientation, training, and support program. METHODS We performed an audit and needs assessment of palliative RT services at our centre. This identified opportunities for improvement that could be facilitated by the CSRT. We defined the CSRT job description including priority responsibilities: (1) optimizing palliative RT services for outpatients and developing a rapid access palliative RT program, (2) optimizing palliative RT services for inpatients at our institution, (3) improving links to community physicians and hospitals caring for patients with advanced cancers. We formed a core resource team to provide ongoing support and to design and implement the orientation and training program. The program involved training in clerical and administrative systems as well as treatment planning and physics training relevant to palliative RT. Clinical placements at several hospitals were arranged in both inpatient and outpatient settings. The CSRT worked with radiation and medical oncologists, palliative care specialists, nurse practitioners, hospitalists, and social workers. RESULTS Through clinical placements and self-directed learning, the CSRT gained knowledge and competencies in patient care coordination, history taking and physical examination, clinical oncology practice including the evidence-based use of palliative RT and symptom control measures, treatment planning, communication, patient advocacy, and advance care planning. We provided practice resources including office space and a planning station, educational opportunities including workshops in palliative and psychosocial care, and research opportunities including methodologic and research ethics training. DISCUSSION To our knowledge, this is the first detailed report of its kind for an advanced practice radiation therapy role. We hope our report will inform the design and implementation of programs elsewhere to help prepare individuals for similar roles in palliative RT. CONCLUSION The CSRT in palliative RT at our institution underwent a comprehensive orientation and training program. Institutions with similar CSRT positions are encouraged to report the details of their own programs.
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Affiliation(s)
- Kelly Linden
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Julie Renaud
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert Zohr
- Radiation Medicine Program, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Alain Haddad
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Pantarotto
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada
| | - Kristopher Dennis
- Division of Radiation Oncology, The Ottawa Hospital and the University of Ottawa, Ottawa, Ontario, Canada.
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Parker SM, Wei RL, Jones JA, Mattes MD. A targeted needs assessment to improve referral patterns for palliative radiation therapy. ANNALS OF PALLIATIVE MEDICINE 2019; 8:516-522. [PMID: 31594377 PMCID: PMC7444431 DOI: 10.21037/apm.2019.08.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/31/2019] [Indexed: 12/25/2022]
Abstract
Radiation therapy (RT) can effectively palliate a variety of symptoms in patients with metastatic cancer, using relatively low doses that infrequently cause major side effects. However, palliative radiation is often underutilized and sub-optimally implemented. In this study, we surveyed the Society of Palliative Radiation Oncology (SPRO) membership to identify barriers to appropriate referral for palliative RT that they encounter in their practice, and identify specific groups of physicians who radiation oncologists believed would benefit most from further education on when to refer patients. A total of 28 radiation oncologists responded to the survey with a response rate of 20.5%. On average, participants felt that referrals for palliative RT were inappropriately delayed 46.5% [standard deviation (STD) 20.2%] of the time. The most common barrier to referral for medical oncologists was thought to be potential interference with systemic therapy (33%); for primary care physicians and surgeons it was a lack of knowledge about the benefit (42%), and for palliative care physicians it was concern for patient convenience (25%). For brain metastases and spinal cord compression radiation oncology was felt to be part of the initial referral sequence more than 50% of the time, but less so for thoracic airway obstruction/bleeding (38%), esophageal obstruction (16%), or urinary obstruction/bleeding (8%), where another subspecialist was more often consulted first. Primary care, geriatric medicine, and emergency medicine were considered among the least knowledgeable specialties about palliative radiation. These hypothesis-generating findings can guide approaches to improve referral patterns for this important aspect of supportive care.
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Affiliation(s)
- Sean M Parker
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Randy L Wei
- Memorial Radiation Oncology Medical Group, Fountain Valley, CA, USA
| | - Joshua A Jones
- Department of Radiation Oncology, Perelman School of Medicine, Philadelphia, PA, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, West Virginia University School of Medicine, Morgantown, WV, USA.
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Champ CE, Beriwal S, Smith RP. Physician Burnout and Physician Health: Three Simple Suggestions for a Complex Problem. Pract Radiat Oncol 2019; 9:297-299. [PMID: 31077886 DOI: 10.1016/j.prro.2019.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/15/2019] [Accepted: 04/29/2019] [Indexed: 11/22/2022]
Affiliation(s)
- Colin E Champ
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Physician Wellness Committee, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ryan P Smith
- Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Martin EJ, Jones JA. Characterizing Palliative Radiotherapy Education in Hospice and Palliative Medicine Fellowship: A Survey of Fellowship Program Directors. J Palliat Med 2019; 23:275-279. [PMID: 31373879 DOI: 10.1089/jpm.2019.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Educational deficiencies among hospice and palliative medicine (HPM) physicians contribute to suboptimal utilization of palliative radiotherapy (PRT) for patients with advanced cancer. Objective: To survey HPM fellowship program directors regarding the need for PRT education in HPM fellowship. Design: We conducted a cross-sectional survey of HPM fellowship program directors in June 2018. We used a 5-point Likert-type scale to assess agreement with statements related to PRT education. Setting/Subjects: Program directors for all United States Accreditation Council for Graduate Medical Education-accredited HPM fellowship programs with at least one enrolled fellow at the time of survey distribution were included. Results: Eighty-one of 120 eligible program directors completed the survey (68% response rate). Nearly all of the respondents agreed that HPM physicians should possess a working knowledge of PRT and that the principles of PRT should be formally taught in HPM fellowship. Thirty percent of HPM fellowship programs, however, lacked a PRT curriculum and only 14% of programs provided more than two hours of PRT education. Limited didactic time, lack of interest among fellows, and lack of collaboration with radiation oncologists were not perceived to be significant barriers to incorporating PRT education into HPM fellowship. More than 75% of program directors indicated that they would consider implementing a PRT curriculum designed specifically for HPM physicians if one were available. Conclusion: There is a need for PRT education in HPM fellowship. This need may be best addressed by developing a widely accessible PRT curriculum designed to meet the needs of HPM physicians.
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Affiliation(s)
- Emily J Martin
- Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Martin EJ, Jones JA. Palliative Radiotherapy Education for Hospice and Palliative Medicine Fellows: A National Needs Assessment. J Palliat Med 2019; 23:268-274. [PMID: 31373870 DOI: 10.1089/jpm.2019.0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Insufficient knowledge of palliative radiotherapy (PRT) among hospice and palliative medicine (HPM) physicians is thought to be a barrier to the provision of high-quality palliative care. Objective: To assess the need for PRT education in HPM fellowship. Design: A cross-sectional survey of HPM fellows was conducted in June 2018. Setting/Subjects: The survey was distributed to accredited HPM fellowship programs in the United States for distribution to enrolled fellows; 114 fellows responded to the survey. Results: Nearly all respondents agreed that the principles of PRT should be taught in HPM fellowship, yet 51% had received no PRT education and 35% had received only one or two hours. Only 25% of respondents rated their working knowledge of PRT as sufficient, 40% felt confident in identifying radiation oncology emergencies or managing radiotherapy side effects, and 52% felt confident in assessing which patients to refer for radiotherapy. More than 75% agreed that were they more knowledgeable about PRT, they would be more likely to consider referral to radiation oncology, to collaborate with radiation oncologists, and to advocate for a short course of treatment based on a patient's prognosis or goals or care. Fellows who received PRT education in fellowship had significantly greater knowledge of and more favorable attitudes toward the use of radiotherapy. This difference was the greatest among fellows who had received at least five hours of PRT education. Conclusion: There is a need for PRT education in HPM fellowship. Efforts to address this need may lead to more appropriate utilization of PRT for patients with advanced cancer.
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Affiliation(s)
- Emily J Martin
- Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Joshua A Jones
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Resende Salgado L, Chang S, Ru M, Moshier E, Ghiassi-Nejad Z, Lazarev S, Smith W, Thompson M, Dharmarajan K. Utilization Patterns of Single Fraction Radiation Therapy for Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e238-e246. [DOI: 10.1016/j.clml.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/21/2019] [Accepted: 02/14/2019] [Indexed: 12/22/2022]
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Wu SY, Singer L, Boreta L, Garcia MA, Fogh SE, Braunstein SE. Palliative radiotherapy near the end of life. BMC Palliat Care 2019; 18:29. [PMID: 30904024 PMCID: PMC6431041 DOI: 10.1186/s12904-019-0415-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/18/2019] [Indexed: 12/25/2022] Open
Abstract
Background A significant proportion of patients with advanced cancer undergo palliative radiotherapy (RT) within their last 30 days of life. This study characterizes palliative RT at our institution and aims to identify patients who may experience limited benefit from RT due to imminent mortality. Methods Five hundred and-eighteen patients treated with external beam RT to a site of metastatic disease between 2012 and 2016 were included. Mann-Whitney U and chi-squared tests were used to identify factors associated with RT within 30 days of death (D30RT). Results Median age at RT was 63 years (IQR 54–71). Median time from RT to death was 74 days (IQR 33–174). One hundred and twenty-five patients (24%) died within 30 days of RT. D30RT was associated with older age at RT (64 vs. 62 years, p = 0.04), shorter interval since diagnosis (14 vs. 31 months, p < 0.001), liver metastasis (p = 0.02), lower KPS (50 vs. 70, p < 0.001), lower BMI (22 vs. 24, p = 0.001), and inpatient status at consult (56% vs. 26%, p < 0.001). Patients who died within 30 days of RT were less likely to have hospice involved in their care (44% vs. 71%, p = 0.001). D30RT was associated with higher Chow and TEACHH scores at consult (p < 0.001 for both). Conclusions Twenty-four percent of patients received palliative RT within 30 days of death. Additional tools are necessary to help physicians identify patients who would benefit from short treatment courses or alternative interventions to maximize quality at the end of life.
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Affiliation(s)
- Susan Y Wu
- Department of Radiation Oncology, University of California, San Francisco, 505 Parnassus Ave, L-75, 1600 Divisadero St., H1031, San Francisco, CA, 94143, USA
| | - Lisa Singer
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Lauren Boreta
- Department of Radiation Oncology, University of California, San Francisco, 505 Parnassus Ave, L-75, 1600 Divisadero St., H1031, San Francisco, CA, 94143, USA
| | - Michael A Garcia
- Department of Radiation Oncology, University of California, San Francisco, 505 Parnassus Ave, L-75, 1600 Divisadero St., H1031, San Francisco, CA, 94143, USA
| | - Shannon E Fogh
- Department of Radiation Oncology, University of California, San Francisco, 505 Parnassus Ave, L-75, 1600 Divisadero St., H1031, San Francisco, CA, 94143, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California, San Francisco, 505 Parnassus Ave, L-75, 1600 Divisadero St., H1031, San Francisco, CA, 94143, USA.
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Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis. Lung Cancer 2019; 135:97-103. [PMID: 31447009 DOI: 10.1016/j.lungcan.2019.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Palliative thoracic radiotherapy (RT) can improve quality of life for patients with advanced lung cancer, but treatment can be associated with acute toxicity and symptomatic relief may take several weeks. The optimal fractionation schedule is not known. Delivery of RT near the end of life (EOL) is an emerging indicator of poor quality care. The aim of this study was to determine utilization of palliative thoracic RT in the last 4 weeks of life, and factors associated with its use, in patients with incurable lung cancer in a population-based healthcare system. MATERIALS AND METHODS All patients with lung cancer in British Columbia treated with palliative thoracic RT in 2014 and 2015 were identified. Associations between starting a course of palliative thoracic RT within 4 weeks of death and patient/treatment characteristics were assessed using univariate and multivariate logistic regression analysis. RESULTS 1676 courses of palliative thoracic RT were delivered to 1584 lung cancer patients. Median survival was 20 weeks. 12% of palliative thoracic RT courses were delivered in the last 4 weeks of life, with short fractionation schedules and simple RT planning techniques used more frequently near EOL. Of RT courses delivered in the last 4 weeks of life 89% were courses of 1 - 5 fractions, 75% were completed as prescribed and 94% involved simple 1-2 field RT techniques. Receipt of RT in the last 4 weeks of life was associated with male gender, younger age, poor performance status, metastatic disease, small cell carcinoma histology and no prior chemotherapy. CONCLUSION Further study and standardization of quality indicators for palliative RT utilization near EOL is required. Whilst clarification occurs, physicians should consider the prognosis of patients with incurable lung cancer and the realistic expectation of benefit from palliative thoracic RT when considering treatment indications and fractionation schedules.
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Grade M, Koenig J, Qian Y, Sandhu N, Liu Y, Turner B, von Eyben R, Knox S, Dudley S. Outcomes and Characteristics of Patients Treated with Emergent Palliative Radiation Therapy. Pract Radiat Oncol 2018; 9:e203-e209. [PMID: 30529795 DOI: 10.1016/j.prro.2018.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/22/2018] [Accepted: 11/26/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Emergent palliative radiation therapy (PRT) of symptomatic metastases can significantly increase the quality of life of patients with cancer. In some contexts, this treatment may be underused, but in others PRT may represent an excessively aggressive intervention. The characterization of the current use of emergent PRT is warranted for optimized value and patient-centered care. METHODS AND MATERIALS This study is a cross-sectional retrospective analysis of all emergent PRT courses at a single academic tertiary institution across 1 year. RESULTS A total of 214 patients received a total of 238 treatment courses. The most common indications were bone (39%) and brain (14%) metastases. Compared with outpatients, inpatients had lower mean survival rates (2 months vs 6 months; P < .001), higher rates of stopping treatment early (19.1% vs 9.0%; P = .034), and greater involvement of palliative care (44.8% vs 24.1%; P < .001), but the same mean planned fractions (9.10 vs 9.40 fractions; P = .669). In a multiple predictor survival analysis, palliative care involvement (P = .025), male sex (P = .001), ending treatment early (P = .011), and having 1 of 3 serious indications (airway compromise, leptomeningeal disease, and superior/inferior vena cava involvement; P = .007) were significantly associated with worse overall survival. CONCLUSIONS Survival is particularly poor in patients who receive emergent PRT, and patient characteristics such as functional status and indication should be considered when determining fractionation schedule and dosing. A multi-institutional study of practice patterns and outcomes is warranted.
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Affiliation(s)
- Madeline Grade
- Stanford University School of Medicine, Stanford, California
| | - Julie Koenig
- Stanford University School of Medicine, Stanford, California
| | - Yushen Qian
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Navjot Sandhu
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Yufei Liu
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Brandon Turner
- Stanford University School of Medicine, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Susan Knox
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Sara Dudley
- Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Palliative care in everyday practice of radiation oncologists : Results from a web-based survey among medical members of the German Society for Radiation Oncology (DEGRO). Strahlenther Onkol 2018; 195:659-667. [PMID: 30498845 DOI: 10.1007/s00066-018-1403-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/13/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Little is known about the attitudes of radiation oncologists towards palliative care, about their competences in this field, and about the collaboration with palliative care specialists. Our aim was to close this gap and understand more about the importance of an additional qualification in palliative care. METHODS Medical members of the German Society for Radiation Oncology (DEGRO) were electronically surveyed during November-December 2016. RESULTS The survey was emailed successfully to 1110 addressees, whereas a total of 205 questionnaires were eligible for analysis (response rate 18.4%). 55 (26.8%) of the respondents had an additional qualification in palliative care. Physicians who had an additional qualification in palliative care (PC qualification) reported palliative care needs for their patients more frequently than the other respondents (89.0 vs. 82.7%, p = 0.008). Furthermore, they were most likely to report a high confidence in palliative care competences, such as "communication skills & support for relatives" (83.6 vs. 59.3%, p = 0.013), "symptom control," and "pain management" (94.5 vs. 67.7%, p < 0.001 and 90.9 vs. 73.3%, p = 0.008, respectively). Respondents with a PC qualification more often involved palliative care specialists than the other respondents (63.3 vs. 39.3%, p = 0.007). Perceived main barriers regarding palliative care in radiation oncology included time aspects (9.2%), stigmata (8.5%), and the lack of interdisciplinary collaboration (8.5%). CONCLUSIONS This analysis demonstrated that aspects of palliative care strongly impact on daily practice in radiation oncology. Additional qualifications and comprehensive training in palliative medicine may contribute to improved patient care in radiation oncology.
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Åsli LM, Myklebust TÅ, Kvaløy SO, Jetne V, Møller B, Levernes SG, Johannesen TB. Factors influencing access to palliative radiotherapy: a Norwegian population-based study. Acta Oncol 2018; 57:1250-1258. [PMID: 29706109 DOI: 10.1080/0284186x.2018.1468087] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Palliative radiotherapy (PRT) comprises half of all radiotherapy use and is an effective and important treatment modality for improving quality of life in incurable cancer patients. We have described the use of PRT in Norway and aimed to identify and quantify the impact of factors associated with PRT utilization. MATERIAL AND METHODS Population-based data from the Cancer Registry of Norway identified 25,281 patients who died of cancer, 1 July 2009-31 December 2011. Additionally, individual-level data on socioeconomic status and community-level data on travel distance were collected. The proportion of patients who received PRT in the last two years of life (PRT2Y) was calculated, and multivariable logistic regression was used to determine factors that influenced the PRT2Y. Analyses of geographic variation in PRT use were also performed for the time period 2012-2016. RESULTS PRT2Y for all cancer sites combined was 29.6% with wide geographic variations (standardized inter-county range; 21.8-36.6%). Female gender, increasing age at death, certain cancer sites, short survival time, and previous receipt of curative radiotherapy were associated with decreased odds of receiving PRT. Patients with low education, those living in certain counties, or with travel distances 100-499 km, were also less likely to receive PRT. Patients with low household income (adjusted odds ratio (OR) = 0.63; 95% confidence interval (CI) = 0.56-0.72) and those diagnosed in hospitals without radiotherapy facility (OR = 0.70; 95% CI = 0.64-0.77) had especially low likelihood of receiving PRT. Significant inter-county variation in use of PRT remained during the time period 2012-2016. CONCLUSIONS Despite a publicly funded, universal healthcare system with equity as a stated health policy aim, utilization of PRT in Norway is significantly associated with factors such as household income and availability of radiotherapy facility at the diagnosing hospital. Even after adjustments for relevant factors, unexplained geographic variations in PRT utilization exist.
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Affiliation(s)
- Linn M. Åsli
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - Tor Å. Myklebust
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Stein O. Kvaløy
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vidar Jetne
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | | | - Tom B. Johannesen
- Department of Registration, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
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Walker GV, Shirvani SM, Borghero Y, Callister MD, Chamberlain DD, Grade EJ, Khan MK, Kumar R, Richmond JG, Roberts TJ, Likhacheva AO. Palliation or Prolongation? The Impact of a Peer-Review Intervention on Shortening Radiotherapy Schedules for Bone Metastases. J Oncol Pract 2018; 14:e513-e516. [PMID: 30059272 DOI: 10.1200/jop.18.00042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Shorter fractionation radiation regimens for palliation of bone metastases result in lower financial and social costs for patients and their caregivers and have similar efficacy as longer fractionation schedules, although practice patterns in the United States show poor adoption. We investigated whether prospective peer review can increase use of shorter fractionation schedules. METHODS In June 2016, our practice mandated peer review of total dose and fractionation for all patients receiving palliative treatment during our weekly chart rounds. We used descriptive statistics and Fisher's exact test to compare lengths of treatment of uncomplicated bone metastases before and after implementation of the peer review process. RESULTS Between July 2015 and December 2016, a total of 242 palliative treatment courses were delivered, including 105 courses before the peer review intervention and 137 after the intervention. We observed greater adoption of shorter fractionation regimens after the intervention. The use of 8 Gy in one fraction increased from 2.8% to 13.9% of cases postadoption. Likewise, the use of 20 Gy in five fractions increased from 25.7% to 32.8%. The use of 30 Gy in 10 fractions decreased from 55.2% to 47.4% ( P = .002), and the use of ≥ 11 fractions decreased from 16.2% before the intervention to 5.8% after ( P = .006). CONCLUSION Prospective peer review of palliative regimens for bone metastases can lead to greater adoption of shorter palliative fractionation schedules in daily practice, in accordance with national guidelines. This simple intervention may therefore benefit patients and their caregivers as well as provide value to the health care system.
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Affiliation(s)
- Gary V Walker
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shervin M Shirvani
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yerko Borghero
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew D Callister
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel D Chamberlain
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Emily J Grade
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mohamed K Khan
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rachit Kumar
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey G Richmond
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Terence J Roberts
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anna O Likhacheva
- Banner MD Anderson Cancer Center, Gilbert, AZ; and The University of Texas MD Anderson Cancer Center, Houston, TX
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Lam MB, Li L, Cronin A, Schrag D, Chen AB. Palliative radiation and fractionation in medicare patients with incurable non-small cell lung cancer. Adv Radiat Oncol 2018; 3:382-390. [PMID: 30202806 PMCID: PMC6128034 DOI: 10.1016/j.adro.2018.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Palliative 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 MATERIALS This 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. RESULTS Among 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). CONCLUSIONS More 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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Affiliation(s)
- Miranda B. Lam
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ling Li
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Angel Cronin
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Deborah Schrag
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Aileen B. Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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Bhulani N, Gupta A, Gao A, Li J, Guenther C, Ahn C, Paulk E, Houck S, Beg MS. Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer. J Gastrointest Oncol 2018; 9:495-502. [PMID: 29998015 DOI: 10.21037/jgo.2018.03.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit (ICU) utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched (PSM) analysis. Results Of the 54,130 patients, 3,166 (5.8%) received palliative care and 70% received it in the last 30 days of life. The proportion of patients receiving palliative care increased from 1.4% in 2000 to 7.4% in 2009 (P<0.001). Patients with palliative care were more likely to be older, Asian and women. In the unmatched and PSM population, the average visits to the ER in the last 30 days of life were significantly higher for patients who received palliative care, and had a significantly higher cost of care. Similarly, ICU length of stay in the last 30 days of life was higher in patients who did not receive palliative care in both PSM and unmatched patients. Cost of care and number of ICU admissions were not different between palliative and non-palliative care groups in PSM and unmatched patients. Conclusions In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.
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Affiliation(s)
- Nizar Bhulani
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ang Gao
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jenny Li
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chad Guenther
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth Paulk
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Stephanie Houck
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Muhammad S Beg
- Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
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