Assessing the utilization of radiotherapy near end of life at a Finnish University Hospital: a retrospective cohort study

Rautakorpi, Liisa; Mäkelä, Johanna; Seyednasrollah, Fatemeh; Hammais, Anna; Laitinen, Tarja; Hirvonen, Outi; Minn, Heikki; Elo, Laura L.; Jyrkkiö, Sirkku

doi:10.1080/0284186x.2017.1324638

Cited by 7 publications

(8 citation statements)

References 22 publications

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“…The prevalence of radiotherapy in the present study is somewhat higher than in the previous studies. In another Finnish study from 2005 to 2013 [22], the corresponding figures were 23% and 12%, respectively. According to previous studies, the proportion of patients receiving radiotherapy one month prior to death varied between 5% and 12% [6,15,[17][18][19].…”

Section: Impact Of Pc Decision On Cancer Treatments In Eolmentioning

confidence: 90%

“…One explanation for higher portion of patients getting radiotherapy at the EOL in this study could be the high proportion (87%) of palliative radiotherapy in the present population. However, according to the study by Rautakorpi et al nearly half of the treatments given in the last two weeks were discontinued, the deterioration of the general condition being the most common reason for the discontinuation [22]. In addition, if radiotherapy is given very late, patients do not obtain any benefit from the treatment [29,30].…”

Section: Impact Of Pc Decision On Cancer Treatments In Eolmentioning

confidence: 99%

“…The utilization of EOL chemotherapy and radiotherapy has previously been investigated [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], but there are no studies on the impact of PC decision-making and timing on anti-cancer treatments at the EOL.…”

Section: Introductionmentioning

confidence: 99%

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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

Hirvonen

Leskelä²,

Grönholm

et al. 2019

Acta Oncologica

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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 ¼ 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 ¼ .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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Section: Impact Of Pc Decision On Cancer Treatments In Eolmentioning

confidence: 90%

Section: Impact Of Pc Decision On Cancer Treatments In Eolmentioning

confidence: 99%

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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

Hirvonen

Leskelä²,

Grönholm

et al. 2019

Acta Oncologica

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“…Dose and fractionation choices informed by accurate prognostic information should minimise toxicity burden, time and hospital visits for the patient and carer. 9,10 Quality of care indicators for patients near end of life has been established for some interventions. Application of quality care indicators suggests that some interventions near end of life (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…4,11,12 Specific quality indicators for RT utilisation in the last 14-30 days of life have not been published. 9 Patients with short life expectancy (less than 4 weeks) are less likely to benefit from palliative RT, and treatment-related acute toxicity may increase their symptom burden in their last weeks of life. 1,3,13 Physicians overestimate patient prognosis, 14 so accurate survival prognostic tools for patients with incurable malignancy are valuable to guide end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

Prognostic tools for survival prediction in advanced cancer patients: A systematic review

et al. 2021

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Survival prediction for palliative cancer patients by physicians is often optimistic. Patients with a very short life expectancy (<4 weeks) may not benefit from radiation therapy (RT), as the time to maximal symptom relief after treatment can take 4-6 weeks. We aimed to identify a prognostic tool (or tools) to predict survival of less than 4 weeks and less than 3 months in patients with advanced cancer to guide the choice of radiation dose and fractionation. We searched Embase, Medline (EBSCOhost) and CINAHL (EBSCOhost) clinical databases for literature published between January 2008 and June 2018. Seventeen studies met the inclusion criteria and were included in the review. Prediction accuracy at less than 4 weeks and less than 3 months were compared across the prognostic tools. Reporting of prediction accuracy among the different studies was not consistent: the Palliative Prognostic Score (PaP), Palliative Prognostic Index (PPI) and Number of Risk Factors (NRF) best-predicted survival duration of less than 4 weeks. The PPI, performance status with Palliative Prognostic Index (PS-PPI), NRF and Survival Prediction Score (SPS) may predict 3-month survival. We recommend PPI and PaP tools to assess the likelihood of a patient surviving less than 4 weeks. If predicted to survive longer and RT is justified, the NRF tool could be used to determine survival probability less than 3 months which can then help clinicians select dose and fractionation. Future research is needed to verify the reliability of survival prediction using these prognostic tools in a radiation oncology setting.

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Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis

et al. 2019

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Assessing the utilization of radiotherapy near end of life at a Finnish University Hospital: a retrospective cohort study

Cited by 7 publications

References 22 publications

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

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

Prognostic tools for survival prediction in advanced cancer patients: A systematic review

Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis

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