Physician-Predicted Prognosis and Palliative Radiotherapy Treatment Utilization at the End of Life: An Audit of a Large Cancer Center Network

Abstract

ContextAt our institution, clinical pathways capture physicians’ prognostication of patients being evaluated for palliative radiotherapy. We hypothesize a low utilization rate of long-course radiotherapy (LCRT) and stereotactic ablative radiotherapy (SAbR) among patients seen at the end of life, especially those with physician-predicted poor prognosis. ObjectiveTo analyze utilization rates and predictors of LCRT and SAbR at the end of life. MethodsA retrospective review was conducted on patients who were evaluated for palliative radiotherapy between January 2017 and August 2019 and died within 90 days of consultation. Binary logistic regression was used to identify predictors for utilization of LCRT (≥10 fractions) and SAbR. ResultsA total of 1608 patients were identified, of which 1038 patients (64.6%) were predicted to die within a year. Six hundred ninety-three patients (66.8%) out of 1038 were prescribed LCRT or SAbR. On a multivariate analysis, patients were less likely to be prescribed LCRT if treated at an academic site (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.23–0.39; P < 0.01) and treated for bone metastases (OR, 0.08; 95% CI, 0.05–0.11; P < 0.01) or other nonbrain/nonbone metastases (OR, 0.19; 95% CI, 0.13–0.30; P < 0.01). SAbR was less likely to be prescribed among patients predicted to die within a year (OR, 0.09; 95% CI, 0.06–0.16; P < 0.01), treated for bone metastases (OR, 0.13; 95% CI, 0.07–0.22; P < 0.01), with poor performance status (OR, 0.51; 95% CI, 0.31–0.85; P = 0.01), and with a breast primary (OR, 0.35; 95% CI, 0.15–0.82; P = 0.02). ConclusionAlthough most patients were predicted to have a limited prognosis, LCRT and SAbR were commonly prescribed at the end of life.