Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy

Abstract

Background/Aim: Previous research has suggested that palliative radiotherapy is a useful measure, unless short survival reduces the time spent without active treatment, and in the case of a low likelihood of experiencing a net benefit in quality of life. Patients with reduced performance status (PS) may be especially at risk of futile treatment, despite having a relatively high symptom burden and thus a potential benefit. Therefore, we analyzed the symptom burden of patients with Eastern Cooperative Oncology Group (ECOG) PS 3-4 in our center. Patients and Methods: A retrospective study was performed of 102 consecutive patients who received palliative radiotherapy for different indications. The Edmonton Symptom Assessment Scale (ESAS) was employed to assess the pre-radiotherapy symptoms. Results: When applying the lowest threshold (ESAS ≥1), up to 97% of patients with PS 3-4 reported symptoms, such as fatigue and dry mouth. When focusing on moderate/severe symptoms (ESAS ≥4), still up to 77% of patients with PS 3-4 reported such a burden. The largest differences between patients with PS 3-4 and those with 0-1 were seen with regard to nausea, fatigue, dry mouth and reduced appetite. The median survival of patients with PS 3-4 was 2 months. Conclusion: Given that many of the symptoms reported by patients with PS 3-4 tend to worsen temporarily after radiotherapy, patients with short survival may not experience a net benefit during the few weeks before death. However, if other symptoms such as dyspnea or pain prevail, short-course radiotherapy may result in worthwhile palliation and should, therefore, be considered on a case-bycase basis and after estimation of the remaining lifespan. 735

Do People Prefer Home Palliative Care? A Survey Study and Assessment of Associated Factors in China

“…Previous findings on marital status were inconsistent; some were non-significant findings while some found that widowed older adults were less likely to go to medicalized settings at the end of life. 32,33 We found that people who were divorced with children or single or never married were more likely to prefer receiving palliative care at home than those married with children. It could be the reason that Chinese people with intact families tend to feel more connected to their families, regardless of the physical location of home; in contrast, those who were not married or divorced might need to be physically at home to feel the sense of being safe and belonged.…”

Associations of baseline patient‐reported outcomes with treatment outcomes in advanced gastrointestinal cancer

“…Multiple prior analyses have demonstrated a relationship between PROs and survival outcomes in several different cancer populations 2,9,30‐32 . In the baseline setting, these findings may be attributed to a higher symptom burden at the initiation of systemic chemotherapy correlating with a lower performance status, a metric also previously shown to correlate with overall survival 33,34 . Patients with reduced performance status and/or higher symptom burden may be less able to tolerate therapy, thus attenuating the ability of cancer treatment to offer survival benefits 35 .…”

“…2,9,[30][31][32] In the baseline setting, these findings may be attributed to a higher symptom burden at the initiation of systemic chemotherapy correlating with a lower performance status, a metric also previously shown to correlate with overall survival. 33,34 Patients with reduced performance status and/or higher symptom burden may be less able to tolerate therapy, thus attenuating the ability of cancer treatment to offer survival benefits. 35 In addition, we found that baseline PROs are associated with unplanned hospitalizations.…”

Thirty-day Mortality in Palliative Radiotherapy: A Retrospective Cohort Analysis in a Single Center

“…However, the balance between providing symptomatic relief and ensuring patient safety remains a critical concern. Patients with a limited life expectancy and a compromised performance status might not derive a net advantage from undergoing palliative radiotherapy (9). There is a pressing need for endeavors directed towards the improvement and precision of the criteria employed for determining the appropriate timing of radiotherapy initiation (10).…”