Palliative radiotherapy (PRT) at end of life (EOL): Benchmarks for a proposed metric.

Abstract

119 Background: The initiation of chemotherapy within 30 days of death is considered a marker of chemotherapy overuse by Quality Oncology Practice Initiative (QOPI). We have previously proposed that the same be considered for RT. However, existing data for PRT delivered at EOL are limited. Methods: We reviewed the published literature for articles reporting PRT at EOL, defined as being within 30 days of death. These articles may be considered as benchmarks for current practice. Results: Published data revealed that frequency of PRT at EOL ranges from 6.2% to 28.6% for adult patients, and an order of magnitude lower in pediatric patients. Many patients received prolonged treatment course, did not complete PRT, and several studies reported median time from PRT to death was less than 2 weeks. A single study reported that only 26% of the patients reported benefit of palliation. The table summarizes published data. Conclusions: Substantial variability exists in published rates and completion of PRT delivery at EOL. Future studies may improve therapy choices at EOL by focusing on efficacy of PRT in this cohort, various PRT techniques including hypofractionation, and clinical variables that predict RT palliation at EOL. [Table: see text]