TY - JOUR
T1 - Early and midtreatment mortality in palliative radiotherapy
T2 - Emphasizing patient selection in high-quality end-of-life care
AU - Ning, Matthew S.
AU - Das, Prajnan
AU - Rosenthal, David I.
AU - Dabaja, Bouthaina S.
AU - Liao, Zhongxing
AU - Chang, Joe Y.
AU - Gomez, Daniel R.
AU - Klopp, Ann H.
AU - Gunn, G. Brandon
AU - Allen, Pamela K.
AU - Nitsch, Paige L.
AU - Natter, Rachel B.
AU - Briere, Tina M.
AU - Herman, Joseph M.
AU - Wells, Rebecca
AU - Koong, Albert C.
AU - McAleer, Mary Frances
N1 - Funding Information:
Funding: Research reported in this article was supported in part by the NIH/ NCI Cancer Center Support (Core) grant CA016672 to The University of Texas MD Anderson Cancer Center.
Publisher Copyright:
© 2021 Harborside Press. All rights reserved.
PY - 2021/7
Y1 - 2021/7
N2 - Background: Palliative radiotherapy (RT) is effective, but some patients die during treatment or too soon afterward to experience benefit. This study investigates end-of-life RT patterns to inform shared decision-making and facilitate treatment consistent with palliative goals. Materials and Methods: All patients who died #6 months after initiating palliative RT at an academic cancer center between 2015 and 2018 were identified. Associations with time-to-death, early mortality (#30 days), and midtreatment mortality were analyzed. Results: In total, 1,620 patients died #6 months from palliative RT initiation, including 574 (34%) deaths at #30 days and 222 (14%) midtreatment. Median survival was 43 days from RT start (95% CI, 41-45) and varied by site (P,.001), ranging from 36 (head and neck) to 53 days (dermal/soft tissue). On multivariable analysis, earlier time-to-death was associated with osseous (hazard ratio [HR], 1.33; P,.001) and head and neck (HR, 1.45; P,.001) sites, multiple RT courses #6 months (HR, 1.65; P,.001), and multisite treatments (HR, 1.40; P5.008), whereas stereotactic technique (HR, 0.77; P,.001) and more recent treatment year (HR, 0.82; P,.001) were associated with longer survival. No difference in time to death was noted among patients prescribed conventional RT in 1 to 10 versus .10 fractions (median, 40 vs 47 days; P5.272), although the latter entailed longer courses. The 30-day mortality group included 335 (58%) inpatients, who were 27% more likely to die midtreatment (P5.031). On multivariable analysis, midtreatment mortality among these inpatients was associated with thoracic (odds ratio [OR], 2.95; P5.002) and central nervous system (CNS; OR, 2.44; P5.002) indications, .5-fraction courses (OR, 3.27; P,.001), and performance status of 3 to 4 (OR, 1.63; P5.050). Conversely, palliative/supportive care consultation was associated with decreased midtreatment mortality (OR, 0.60; P5.045). Conclusions: Earlier referrals and hypofractionated courses (#5-10 treatments) should be routinely considered for palliative RT indications, given the short life expectancies of patients at this stage in their disease course. Providers should exercise caution for emergent thoracic and CNS indications among inpatients with poor prognoses due to high midtreatment mortality.
AB - Background: Palliative radiotherapy (RT) is effective, but some patients die during treatment or too soon afterward to experience benefit. This study investigates end-of-life RT patterns to inform shared decision-making and facilitate treatment consistent with palliative goals. Materials and Methods: All patients who died #6 months after initiating palliative RT at an academic cancer center between 2015 and 2018 were identified. Associations with time-to-death, early mortality (#30 days), and midtreatment mortality were analyzed. Results: In total, 1,620 patients died #6 months from palliative RT initiation, including 574 (34%) deaths at #30 days and 222 (14%) midtreatment. Median survival was 43 days from RT start (95% CI, 41-45) and varied by site (P,.001), ranging from 36 (head and neck) to 53 days (dermal/soft tissue). On multivariable analysis, earlier time-to-death was associated with osseous (hazard ratio [HR], 1.33; P,.001) and head and neck (HR, 1.45; P,.001) sites, multiple RT courses #6 months (HR, 1.65; P,.001), and multisite treatments (HR, 1.40; P5.008), whereas stereotactic technique (HR, 0.77; P,.001) and more recent treatment year (HR, 0.82; P,.001) were associated with longer survival. No difference in time to death was noted among patients prescribed conventional RT in 1 to 10 versus .10 fractions (median, 40 vs 47 days; P5.272), although the latter entailed longer courses. The 30-day mortality group included 335 (58%) inpatients, who were 27% more likely to die midtreatment (P5.031). On multivariable analysis, midtreatment mortality among these inpatients was associated with thoracic (odds ratio [OR], 2.95; P5.002) and central nervous system (CNS; OR, 2.44; P5.002) indications, .5-fraction courses (OR, 3.27; P,.001), and performance status of 3 to 4 (OR, 1.63; P5.050). Conversely, palliative/supportive care consultation was associated with decreased midtreatment mortality (OR, 0.60; P5.045). Conclusions: Earlier referrals and hypofractionated courses (#5-10 treatments) should be routinely considered for palliative RT indications, given the short life expectancies of patients at this stage in their disease course. Providers should exercise caution for emergent thoracic and CNS indications among inpatients with poor prognoses due to high midtreatment mortality.
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U2 - 10.6004/jnccn.2020.7664
DO - 10.6004/jnccn.2020.7664
M3 - Article
C2 - 33878727
AN - SCOPUS:85112297997
SN - 1540-1405
VL - 19
SP - 805
EP - 813
JO - JNCCN Journal of the National Comprehensive Cancer Network
JF - JNCCN Journal of the National Comprehensive Cancer Network
IS - 7
ER -