|Publication Type||Journal Article|
|Year of Publication||2017|
|Authors||Li D, Prigerson HG, Kang J, Maciejewski PK|
|Journal||J Pain Symptom Manage|
|Date Published||2017 01|
|Keywords||Aged, Female, Humans, Male, Middle Aged, Palliative Care, Prospective Studies, Quality of Life, Radiotherapy, Terminal Care, Terminally Ill|
CONTEXT: Radiation therapy (RT) is used with palliative intent in patients with advanced stage cancer. Prior studies, primarily in patients with poor performance status (PS), suggest that RT is associated with aggressive medical care, which may impact patients' quality of life near death (QoD) adversely.
OBJECTIVE: This study examines associations between RT use and patients' receipt of aggressive care and QoD based on patients' PS.
METHODS: This is a multi-institutional, prospective cohort study of patients with end-stage cancers (N = 312) who were identified as terminally ill at study enrollment. RT use (n = 24; 7.7%) and Eastern Cooperative Oncology Group (ECOG) PS were assessed at study entry (median = 3.8 months before death). Aggressive care near death was operationalized as use of mechanical ventilation and/or resuscitation in the last week of life. QoD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.
RESULTS: RT use was associated with higher QoD (8/8, 100.0%, vs. 58/114, 50.9%; P = 0.006) among patients with good PS (ECOG = 1), more aggressive care near death (3/9, 33.3%, vs. 6/107, 5.6%; P = 0.020) among patients with moderate PS (ECOG = 2), and lower QoD (1/7, 14.3%, vs. 28/51, 54.9%; P = 0.046) among patients with poor PS (ECOG = 3).
CONCLUSIONS: Targeted use of RT in end-of-life cancer care may benefit patients with good PS, but its use may adversely affect patients with poorer PS. Decisions about RT use in this setting should consider likely end-of-life outcomes based on patients' current PS.
|Alternate Journal||J Pain Symptom Manage|
|PubMed Central ID||PMC5385851|
|Grant List||R35 CA197730 / CA / NCI NIH HHS / United States |
R01 MD007652 / MD / NIMHD NIH HHS / United States
R01 CA106370 / CA / NCI NIH HHS / United States
R01 MH063892 / MH / NIMH NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States