PV QA 3 - Poster Viewing Q&A 3
Purpose/Objective(s): Palliative Radiation Therapy (PRT) is often used for patients with advanced oncologic malignancies to alleviate pain and provide improved quality of life. However, there is little data regarding unexpected cessation of treatment in patients undergoing PRT. The primary objective of this study was to look at factors that contributed to an unexpected stop in treatment for patients receiving PRT on an emergent basis.
Materials/Methods: We conducted a retrospective, case-series review of patients treated with emergent radiation therapy in calendar year 2014 who stopped treatment before completing their course of therapy. Patient charts were reviewed for the following data: demographic information, fractionation schedule, indication for treatment, palliative care involvement, duration of treatment and treatment outcomes.
Results: A total of thirty-five emergent cases were identified. Of the thirty-five patients reviewed for early discontinuation of treatment, symptomatic bone metastases and leptomeningeal disease accounted for the most common emergent PRT indications. The distribution of indications in the case series was as follows: painful bone metastases (28%), leptomeningeal disease (20%), painful soft tissue metastases (8.5%), spinal cord compression (8.5%), airway compromise (8.5%), brain metastases (8.5%), SVC/IVC compression (8.5%) and bleeding (5.7%). Lung was the most common primary site(34%). Other primary sites included breast (20%), gastrointestinal (14%), gynecologic (11%), genitourinary (8.5%), and hematologic (8.5%). The majority of patients had an ECOG of 1 or 2 at the beginning of treatment. Of the 35 patients, palliative care was involved in less than half of the patients. 83% of patients died within an average of 11 weeks from the start of their RT course after prematurely stopping treatment.
Conclusion: Two processes were identified for early cessation of radiation therapy: disease progression and concurrent hospice referral. These results highlight the importance of palliative care discussion in the management of emergent PRT cases. Clinicians should strive to incorporate palliative care in radiation oncology to ensure improved end of life care in patients with advanced cancer. Careful consideration should be given to the ultimate value of radiation at the end of life.
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