Palliative radiation not properly tailored to patient life expectancy

Patients with end-stage cancer who were prescribed palliative radiation did not benefit from the treatment and often spent a significant portion of their remaining life undergoing treatment, according to a small single-institution study.

Palliative radiotherapy for end-stage cancer patients is intended to control cancer-related pain and other symptoms and to help patients maintain a good quality of life when long-term cancer control is not possible, according to background information in the study. However, drawing a conclusion from this study, researchers wrote, “Our study illuminates the current limits of our ability to predict death even when it is very close and to provide effective survival-time-adapted palliation.” This resulted in few patients on study receiving the benefit of palliative radiation.

In the study, 216 patients were referred for palliative radiation. The researchers examined the 33 patients in the group who died within 30 days.

Median age of the patients was 65 years and the median survival time was 15 days. Ninety-one percent of patients had a Karnofsky performance status less than 50%.

Independent survival estimates were obtained for 31 patients. Sixteen percent of the votes estimated survival to be fewer than 30 days, 62% estimated survival to be one to six months, and 21% estimated survival to be six months or more.

After palliative radiation, only 25.8% of patients reported improved or stable symptoms; 51.6% of patients reported worsened symptoms and 41.9% of patients had to discontinue radiation due to death or deteriorating status.

Half of the patients on study spent more than 60% of their remaining survival time undergoing therapy.

“Survival overestimates may have contributed to mismatched fractionation schedules, a considerable waste of time, and the high percentage of patients who discontinued therapy,” the researchers wrote.

Gripp S. Cancer. 2010;doi:10.1002/cncr.25112.