Characteristics of urgent palliative cancer care consultations encountered by radiation oncologists
Background Palliative radiation therapy (PRT) is often used in patients with advanced cancers who require urgent consultation.
Objective To report on the characteristics of urgent palliative issues encountered by radiation oncologists.
Methods Patterns of presentation in 162 consultations for urgent PRT at 3 centers were prospectively evaluated from May 19 to September 26, 2014. A survey of palliative care issues, including assessment of reasons for urgent consultation, disease presentation, characteristics, and sites of RT delivery, was completed by physicians and/or nurse practitioners. The response rate was 86%, with 140 of 162 responses received.
Results The median age of the patients was 63 years, with 80% older than 50 years. 56% were men, and 44% were women. 57% had an Eastern Cooperative Oncology Group Performance Status of 0-1. Primary cancer diagnoses were lung (28%), breast (13%), prostate (10%), melanoma (10%), sarcoma (7%), and others (32%). The main reasons for PRT consult were pain (57%), brain metastases (29%), and cord compression (13%). The most common presenting symptoms were pain (69%), neurologic symptoms (51%), and fatigue (49%). Patients were seen throughout the trajectory of their care as follows: 63% at the time of an established metastasis, 19% at the time of their initial diagnosis continuing further cancer therapies, and 16% before hospice care without further anticancer therapy.
Limitations Single institution and descriptive
Conclusions PRT occurs across the spectrum of advanced cancer, from initial diagnosis to end of life, and is used in a range of urgent oncologic issues, mostly painful metastases, followed by brain metastases and cord compression. Radiation oncologists manage cancer-related symptoms such as pain, neurologic symptoms, and fatigue.
Accepted for publication July 17, 2018
Correspondence Muhammed M Fareed, MD; mmfareed@bwh.harvard.edu
Disclosures The authors report no disclosures or conflicts of interest.
Citation JCSO 2018;16(4):e193-e199
©2018 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0415
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Limitations
There are a few limitations to this study. First, this is a survey-based study conducted at a single academic center within an urban setting and surrounding community regions, which affects its generalizability. Second, this study presents perspectives of radiation oncology practitioners evaluating patients and does not directly reflect patient perceptions or report of symptoms. Third, the data provided by this study are solely descriptive in nature. However, this can guide hypothesis-driven research regarding the evaluation and management of urgent palliative care issues encountered by radiation oncology clinicians and suggest educational objectives to address the needs of these patients.
Conclusions
Radiation oncologists are involved throughout the trajectory of care for advanced cancer patients. Furthermore, they manage a variety of urgent oncologic issues, most commonly metastases causing pain, brain metastases, and spinal cord or cauda equina compression. Radiation oncologists also manage many cancer-related symptoms, mostly pain, neurologic symptoms, fatigue, and gastrointestinal symptoms. These findings point toward the need for palliative care to be well integrated into radiation oncology training curricula and the need for dedicated care structures that enable rapid and multidisciplinary palliative oncology care within radiation oncology departments.
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