Knowledge and Utilization of Palliative Radiotherapy by Pediatric Oncologists

T L Tucker,R S Samant,E J Fitzgibbon

doi:10.3747/co.v17i1.460

Abstract

Palliative radiotherapy (PRT) is a routine part of oncology care in adult patients, but it is used much less frequently among children with incurable cancer. We surveyed Canadian pediatric oncologists to learn about their knowledge and use of PRT and to identify potential barriers to referral. A 13-item questionnaire assessing PRT knowledge and utilization was sent to 80 Canadian pediatric oncologists. The survey completion rate was 80%, with most respondents being providers of palliative care for children and making referrals for PRT. Although 62% had received training in radiation oncology, only 28% had received formal palliative care training. Respondents with palliative care training were found to be significantly more knowledgeable about PRT and were more likely to refer children for PRT (p < 0.01). Only 59% of respondents thought that they had adequate knowledge about the indications for PRT. A positive correlation was found between knowledge about the indications for PRT and referral for treatment (p < 0.01). Among survey respondents, 51% believed that PRT was underutilized, and the perceived barriers to PRT referral included patient or family reluctance, distance to the cancer centre, belief that PRT has little impact on quality of life, and concerns about toxicity. Palliative radiotherapy is considered to be underutilized among children. This situation appears to be related, in part, to inadequate knowledge and training among pediatric oncologists, suggesting that more emphasis needs to be placed on pediatric palliative care education.

Highlights

Radiotherapy plays a vital role in the management of many patients with cancer, in both treatment intended for cure and treatment in which the primary intent is palliation of symptoms
This situation appears to be related, in part, to inadequate knowledge and training among pediatric oncologists, suggesting that more emphasis needs to be placed on pediatric palliative care education
Surveys were sent to 80 pediatric oncologists across Canada for whom addresses were available—a group that represented a majority of these specialists among the estimated 90 in the country

Summary

Introduction

Radiotherapy plays a vital role in the management of many patients with cancer, in both treatment intended for cure and treatment in which the primary intent is palliation of symptoms. Despite the growing literature to support the use of palliative radiotherapy for symptom management and quality-of-life improvement [1,5,6,7,8] in adult patients, there remains a problem of underutilization of this treatment option [2,3,4,9]. Several reasons for underutilization have been identified, including short life expectancy for the patient, transportation difficulties, lack of a coordinated team approach to end-of-life care, and a lack of comfort on the part of primary physicians with their radiotherapy knowledge [4,9,10,11]. Palliative radiotherapy (prt) is a routine part of oncology care in adult patients, but it is used much less frequently among children with incurable cancer. We surveyed Canadian pediatric oncologists to learn about their knowledge and use of prt and to identify potential barriers to referral

Results

Discussion

Conclusion