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Abstract
BackgroundThe use of palliative radiotherapy (PRT) is variable in advanced cancer. Little is known about PRT utilization by end-of-life (EOL) cancer patients in Canada. This study examined the PRT utilization rates and factors associated with its use in a cohort of cancer patients who died in British Columbia (BC).MethodsBC residents with invasive cancer who died between April 1, 2010 and March 31, 2011 were included in the study. Their cancer registry and radiotherapy treatment records were extracted from the BC Cancer Agency information systems and linked for the analysis. The PRT utilization rates by age, sex, primary cancer diagnosis, geographic region, survival time and travel time to the cancer centre were examined. Multivariable logistic regression was used to determine the factors that influenced the PRT utilization rates.ResultsOf the 12,300 decedents in the study 2,669 (21.7%) had received at least one course of PRT in their last year of life. The utilization rates dropped to 5.0% and 2.2% in the last 30 and 14 days of life, respectively. PRT utilization varied across diagnosis and was highest for lung cancer (45.7%) and lowest for colorectal cancer (8.9%). The rates also varied by age, survival time and travel time to the nearest radiotherapy centre. There was a greater odds of receiving PRT for those with primary lung cancer, survival time between 1.5-26 months from diagnosis or living within 2 hours from a cancer centre. The 85+ age group was least likely to receive PRT in their last year of life.ConclusionsThis study found PRT utilization rates of EOL cancer decedents to be variable across the province of BC. Age, diagnosis, survival time and travel time to the nearest radiotherapy centre were found to influence the odds of PRT treatment. Further work is still needed to establish the appropriate PRT utilization rates for the EOL cancer population.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-684X-13-49) contains supplementary material, which is available to authorized users.
Highlights
The use of palliative radiotherapy (PRT) is variable in advanced cancer
This paper describes a retrospective cohort study on PRT utilization rates of EOL cancer decedents in British Columbia (BC)
Study cohort characteristics An initial cohort of 13,250 decedents who died between April 1, 2010 and March 31, 2011 were identified from the BC Cancer Registry
Summary
The use of palliative radiotherapy (PRT) is variable in advanced cancer. Little is known about PRT utilization by end-of-life (EOL) cancer patients in Canada. Palliative radiotherapy (PRT) is an established treatment modality in the management of advanced cancer [1]. It is a potentially effective treatment option for cancer patients at end of life (EOL) to enhance their quality of life when faced with only weeks or months to live [2]. One study estimated that approximately 50% of all RT treatments are prescribed with aware of other population-based PRT utilization data or estimated optimal rates for EOL cancer patients in Canada. Understanding PRT use by EOL cancer patients can provide valuable information for cancer care providers and policy makers in assessing whether these patients have adequate PRT access to improve their quality of life
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