Comprehensive Assessment of Care Needs During Palliative Radiotherapy Consultation Optimizes Provision of Supportive Care for Patients With Breast Cancer

Abstract

Optimizing provision of supportive care in incurable cancer can be facilitated by routine screening for symptoms and functional interference to direct referrals to appropriate allied health professionals (AHP) and specialist palliative care (SPC). At the Cross Cancer Institute (CCI), patients requiring consultation for palliative radiotherapy (PRT) can be assessed in multiple settings, including through a dedicated multidisciplinary Palliative Radiation Oncology (PRO) clinic. We describe comprehensive needs assessment by setting of PRT consultation.This secondary analysis of routinely collected data examined female patients with breast cancer who died between 04/01/2013 and 03/31/2014, and had at least one PRT consultation. Systematic screening for patient-reported symptoms was not widespread. Referrals to AHPs and SPC, and setting of PRT consultation, were at the attending physicians' discretion. Clinical data were abstracted including Karnofsky performance status (KPS) and Edmonton Symptom Assessment System (ESAS) ratings. Summary statistics were calculated and t tests of proportions compared groups.Of 130 patients, 9 did not have PRT, 65 had one course, 33 had two, and 23 had three or more, with on average 1.3 sites treated per course. 28/224 (12.5%) total PRT consults took place in the PRO clinic. KPS was documented in 30.1% versus 89.3%; medication history in 53.6% versus 96.4%; and symptom-directed medications in 47.4% versus 96.4% of non-PRO versus PRO visits, respectively (all P < 0.0001). Baseline and follow-up ESAS scores were available for 67.9% and 35.7% of PRO visits, respectively, and not available for any non-PRO visit. PRO consults had a higher proportion of subsequent AHP referrals (50% versus 8.2%; P < 0.0001). Frailty score could be retrospectively derived in 89.3% of PRO versus 44.4% of non-PRO consults (P < 0.0001).Assessment for PRT by a dedicated multidisciplinary team utilizing patient-reported screening tools provides a comprehensive picture of overall function and symptom burden. The resulting ability to tailor supportive care referrals is essential to personalization of end-of-life care.