Symptom duration and delay in referral for palliative radiotherapy in cancer patients: a pilot study

Abstract

ObjectiveTo estimate the frequency of delay in referral for palliative radiotherapy (PRT), and to identify factors associated with delay. DesignProspective survey over three months in 1997. SettingRadiotherapy department of a cancer centre in Melbourne, Victoria. Participants158 consecutive patients prescribed PRT in the lung, breast, urology and haematology units. Main outcome measuresDuration of symptoms; incidence of "unreasonable" delay in referral; and incidence of negative clinical outcome associated with referral delay. ResultsThe median duration of symptoms before prescription of radiotherapy was four weeks. Thirty‐eight patients (24%) were considered to have had an unreasonable delay in referral, with median symptom duration of 15 weeks, and median delay in referral of 12 weeks. Causes of delay were classified as "diagnostic uncertainty" (29%), "other treatment given" (18%), "patient related" (18%), "language difficulty” (3%), and "unexplained" (32%). Twenty‐seven of these 38 patients (71%) had negative outcomes, including persistent pain, neurological deterioration and persistent respiratory symptoms. ConclusionsThese data suggest that delay in referral for PAT is not uncommon, has a variety of causes and can result in negative clinical outcomes. There appears to be a need for greater awareness of patients' symptoms and of the role of PRT among clinicians caring for patients with cancer.

Provider perspectives on palliative care needs at a major teaching hospital

“…One concern, however, which was raised repeatedly by respondents in this study, was the waiting time for patients to receive palliative radiotherapy. 31 Moreover, there is evidence that delays in palliative radiotherapy may result in unnecessary suffering and morbidity. 30 The role of radiotherapy in the palliation of pain and other symptoms of advanced malignancy is well established.…”

Management of cases that might benefit from radiotherapy: a standardised patient study in primary care

“…However, only 38% of all cancer patients currently receive radiotherapy in Australia (Baume 2002). Delay in referral for radiotherapy is not uncommon and occurs for these reasons: diagnostic uncertainty, incorrect prioritisation of treatment, patientrelated factors and other reasons (Wirth et al 1998). Delay in referral for radiotherapy is not uncommon and occurs for these reasons: diagnostic uncertainty, incorrect prioritisation of treatment, patientrelated factors and other reasons (Wirth et al 1998).…”

“…Factors that affected referral included uncertainty about benefits, life expectancy, location of practice and whether the GP had previously referred patients for radiotherapy. However, delayed radiotherapy leads to poorer outcomes, neurological deterioration, persistent symptoms, and negatively impacts on the psychological health of patients (Wirth et al 1998;Kenny & Lehman 2004). However, delayed radiotherapy leads to poorer outcomes, neurological deterioration, persistent symptoms, and negatively impacts on the psychological health of patients (Wirth et al 1998;Kenny & Lehman 2004).…”

Innovative program for palliative radiotherapy in Australia

“…Patients presenting for palliative radiotherapy are often of poor performance status and often have difficulty attending the radiation department for multiple visits. Delays in treatment may result in excessive and unnecessary morbidity, as well as prolonged suffering due to pain 9 . While reasons for delay are multifactorial, 10 the inherent delay in the traditional practice of RT referral, consultation, planning, and treatment is a significant factor.…”

“…Delays in treatment may result in excessive and unnecessary morbidity, as well as prolonged suffering due to pain. 9 While reasons for delay are multifactorial, 10 the inherent delay in the traditional practice of RT referral, consultation, planning, and treatment is a significant factor. In conventional practice, patients treated with palliative radiotherapy may be required to make multiple visits to the centre for consultation, simulation and delivery of RT.…”