Palliative Radiotherapy Delivery by a Dedicated Multidisciplinary Supportive Care Team: Facilitating Early Integration of Palliative Care for Patients With Breast Cancer

Abstract

Despite level one evidence that early integration of specialist palliative care (SPC) improves quality of life, patients tend to access SPC late in their disease trajectory, if at all. Widespread accessibility of generalist PC competencies has been increasingly provided by dedicated palliative radiotherapy (PRT) clinics, such as the multidisciplinary Palliative Radiation Oncology (PRO) program at our institute. We evaluated the interaction between PRT delivery and need for SPC referral.This secondary analysis of routinely collected health data examined adult female patients with breast cancer, deceased between 04/01/2013 and 03/31/2014. Alberta Cancer Registry, electronic medical records, and Palliative Care Program data were linked. Referrals for PRT and SPC were at the attending physicians' discretion. Clinical data were abstracted including intervals between PRT and SPC consultations. Summary statistics were calculated and independent samples median tests were used for comparison.Of our study cohort of 194 patients, 130 (67.0%) had at least one PRT consult, and 111 (57.2%) were assessed by SPC. First PRT and SPC consultations occurred a median of 11.5 months (interquartile range 3.6-22.1 mos) and 2.8 mos (IQR 0.9 -6.1 mos) before death, respectively. 65.6% (42/64) of those who never had PRT received SPC involvement, versus 53.1% (69/130) of those receiving PRT consult. In the absence of previous PRT, patients had SPC consultation a median of 1.5 mos prior to death (IQR 0.6-4.9 mos); those who had PRT first were seen by SPC a median of 3.3 mos prior (IQR 1.2-6.4 mos) (P = 0.08). Patients seen for PRT outside versus within the PRO clinic had SPC consultation a median of 3.2 mos (IQR 1.2-6.1 mos) versus 5.5 mos prior to death (IQR 2.3-7.1 mos), respectively (P = 0.95).Fewer advanced breast cancer patients who underwent PRT ultimately required SPC consultation, but those who did trended towards referral earlier in their disease course, especially if PRT delivery took place in the setting of a dedicated multidisciplinary team.