Use of RT for Palliative End-of-Life Cancer Care 'Deserves Further Study'
(ChemotherapyAdvisor)–The proportion of US elderly patients dying of cancer who receive radiation therapy (RT) in the last month of life is low; however, of those, nearly 1 in 5 spend more than 10 of their final 30 days receiving RT, a study reported in the Journal of Clinical Oncology online November 19.
“This investigation offers the first US population-based assessment of the use of radiotherapy in the end-of-life setting,” noted B. Ashleigh Guadagnolo, MD, MPH, of the Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, and colleagues.
Using the Surveillance Epidemiology and End Results (SEER)-Medicare linked databases to evaluate use and associated costs of RT therapy in the last month of life, they analyzed claims data for 202,299 patients dying from cancer of the lung, breast, prostate, colorectal, and pancreas from 2000 to 2007.
Adjusted analyses of potential impacts of demographic, health services, and treatment-related variables on receipt of RT and treatment with greater than 10 days of RT were conducted and costs were calculated in 2009 dollars.
“Among the 15,287 patients (7.6%) who received RT in the last month of life, its use was associated with nonclinical factors such as race, gender, income, and hospice care,” they reported; of these, 2,721 (17.8%) received more than 10 days of treatment.
Non-Hispanic white race, no receipt of hospice care, and treatment in a freestanding vs a hospital-associated facility were identified as the nonclinical factors associated with a greater likelihood of receiving more than 10 days of RT in the last 30 days of life. Among those who received RT, hospice care was associated with 32% decrease in total costs of care in the last month of life.
“Radiotherapy can provide needed palliation for patients with advanced cancer. It is possible, on the basis of overall low percentage of patients who received radiotherapy in the last 30 days of life, that there is underuse of this modality in end-stage cancer care. However, dosing regimens that require dying patients to spend a significant proportion of their final days visiting a radiation therapy suite likely counters the overall aim of palliative care,” they wrote.
“Recently published guidelines regarding dosing for palliative regimens may facilitate concordance between the number of radiation treatments patients receive in their final days and the number they need for effective palliation, and this deserves further study,” they concluded, adding that “further research is needed into quality of care, physician incentives, and costs for radiotherapy in end-of-life cancer care.”