Palliative radiotherapy tailored to life expectancy in end‐stage cancer patients

Abstract

BACKGROUND:The purpose of the study was to investigate the adequacy of palliative radiation treatment in endstage cancer patients. METHODS: Of 216 patients referred for palliative radiotherapy, 33 died within 30 days and constitute the population of the study. Symptoms, Karnofsky Performance Status (KPS), laboratory tests, and survival estimates were obtained. Treatment course was evaluated by medical records. Univariate analyses were performed by using the 2-sided chi-square test. With significant variables, multiple regression analysis was performed. RESULTS: Median age was 65 years, and median survival was 15 days. Prevailing primary cancer types were lung (39%) and breast (18%). Metastases were present in 94% of patients, brain (36%), bone (24%) and lung (18%). In 91%, KPS was <50%. KPS, lactate dehydrogenase, dyspnea, leucocytosis, and brain metastases conveyed a poor prognosis. From 85 survival estimates, only 16% were correct, but 21% expected more than 6 months. Radiotherapy was delivered to 91% of patients. In 90% of radiation treatments, regimens of at least 30 Gy with fractions of 2-3 Gy were applied. Half of the patients spent greater than 60% of their remaining lifespan on therapy. In only 58% of patients was radiotherapy completed. Progressive complaints were noted in 52% and palliation in 26%. CONCLUSIONS: Radiotherapy was not appropriately customized to these patients considering the median treatment time, which resembles the median survival time. About half of the patients did not benefit despite spending most of their remaining lives on therapy. Prolonged irradiation schedules probably reflect overly optimistic prognoses and unrealistic concerns about late radiation damage. Single-fraction radiotherapy was too seldom used. Cancer 2010;116:3251-6.

Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer

“…[18][19][20][21] In a recent study, for example, radiation oncologists only accurately identified 5 of 33 patients who would die within 1 month of starting palliative RT. 22 Moreover, they predicted that 7 of the 33 patients who died were going to live for at least 6 months. Reflecting this optimism, only 61% of their patients completed treatment as prescribed, which is only slightly better than the rate of 53% identified in the current study.…”

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

“…Clinicians are often excessively optimistic when estimating the life expectancy of patients with advanced cancer, which may lead to treatment decisions that eventually become a burden for patients and caregivers, without improving the quality of life of the patients during the terminal phase of the disease (8,9). A recent audit of clinical practice in Nordland Hospital (Bodø, Nordland, Norway) between 2007 and 2009 revealed that 9% of all palliative radiotherapy was administered to patients during their last month of life (10).…”

Experiencia De Tratamiento Paliativo en Metástasis Óseas

“…El manejo paliativo de los pacientes con cáncer representa prácticamente la mitad de las indicaciones de radioterapia 3,8 .…”

“…Por otro lado, es importante considerar que el tipo de tratamiento debe ser elegido de acuerdo a las condiciones y expectativas de vida de cada paciente. Un estudio que evaluó a pacientes que murieron al mes de haber ingresado a radioterapia, mostró que un 77% de ellos tenía planes de tratamiento largos de 30 a 40 Gy, sólo un 58% de los pacientes completaron el plan y la mitad de los pacientes pasó el 60% de su vida restante en terapia 8 . Es importante procurar alcanzar el máximo efecto con el mínimo tratamiento en el manejo paliativo de los pacientes con cáncer con expectativa de vida limitada, con el fin de aumentar la calidad de vida restante 5 .…”