Which Factors Determine Pain Relief From Spine Radiosurgery in Patients With Spine Metastases?: Results From a Large Single Institution Series

Abstract

of care that match a patient’s wishes with potential treatment options as well as aiding in symptom management. In addition, Palliative care can provide access to hospice services when aggressive care is no longer realistic. As the very indication for WBRT remains prognostic, here we investigate the integration of palliative care in patients requiring WBRT. Materials/Methods: Patients with a solid malignancy and histologic or radiographic evidence of brain metastases who were referred to our institution between July 2011 and June 2012 were reviewed retrospectively. All patients received WBRT alone. Patient demographics, the number of emergency room visits in the last 6 months of life, and referrals to palliative care (including the referring physician) were evaluated. Results: Ninety-nine patients were diagnosed with brain metastases and treated with WBRT alone. At time of review, 85 had died, 13 were living, and 1 patient was lost to follow-up. 28 of the 85 deceased patients presented to the emergency department 2 times in the last six months of their life. Palliative care referrals were made in 67 patients. Of these referrals, 57% were during an in-patient hospitalization. The median survival after WBRTwas 64 days. The median survival after palliative care referral was 27 days. Only 26 patients were referred to palliative care during WBRT or 1 week before or after WBRT. Only 3% of patients were referred by a Radiation Oncologist. In this cohort, palliative care referral could not be correlated to age, social support, histology, or gender. Conclusions: Patients with brain metastasis requiring WBRT continue to have a predictable dying trajectory regardless of age or histology. Despite objective data to indicate a limited life expectancy, timely referrals to palliative care remain inadequate. The common pattern of care at our institution after WBRT was an acute hospital admission prompting a referral to palliative care by an inpatient service. Palliative care referrals continued to be late in the dying process and were infrequently placed by the primary oncologists. Brain metastases requiring WBRT can be used as objective criteria for the primary oncologist to engage in end of life discussions and involve palliative care services sooner. Author Disclosure: M.J. Stavas: None. K.O. Arneson: None. J.M. Friedman: None. S. Misra: None.