Use of radiation within the last year of life among cancer patients

Publication date: Available online 31 January 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Yolanda D. Tseng, Nathan W. Gouwens, Simon S. Lo, Lia M. Halasz, Phil Spady, Irina Mezheritsky, Elizabeth Loggers
BackgroundWe examined radiotherapy (RT) utilization within the last year of life (LYOL). As palliative RT (PRT) has been well studied in patients with ≥6-week life expectancies, we hypothesized that PRT use would be constant over the LYOL, except for the last 30 days, when use would decline given lack of prospective data supporting its use.MethodsAt a single institution, 870 cancer patients died between 10/1/2014-9/30/2015 and had ≥3 evaluation and management visits within the LYOL. Claims and RT data were extracted and linked. Over the LYOL, we evaluated RT utilization by intent (curative versus palliative) and indications.ResultsWithin the LYOL, one-third of patients (RT365) underwent RT to 444 sites, which decreased to 24.3% and 8.5% in the last 180 and 30 days of life, respectively. RT365 patients were younger at death and had a higher proportion of lung, sarcoma, and transplant disease groups. One-quarter of sites were irradiated with curative intent, which remained constant over the LYOL. In contrast, PRT was utilized at a supralinear rate, in which treatment of bone metastases and use of single-fraction PRT increased closer to death.ConclusionsPRT appears to be disproportionately utilized closer to death with an increasing proportion of irradiated sites being bone metastases. This may be secondary to increased symptoms from advanced cancer toward the end of life (EOL). As patients with very poor prognosis (e.g. within 30 days of death) are generally not included in RT clinical trials, further studies are warranted to assess whether PRT for bone metastases at the EOL is efficacious.

Teaser

Utilization of RT over the last year of life among cancer patients is not well characterized. In this large, single institution retrospective study, we found that RT is variably used across histologies and over the last year of life, with palliative RT being disproportionately delivered closer to death.


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