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Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death.

Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death.

Title
Publication TypeJournal Article
Year of Publication2017
AuthorsLi D, Prigerson HG, Kang J, Maciejewski PK
JournalJ Pain Symptom Manage
Volume53
Issue1
Pagination25-32
Date Published2017 01
ISSN1873-6513
KeywordsAged, Female, Humans, Male, Middle Aged, Palliative Care, Prospective Studies, Quality of Life, Radiotherapy, Terminal Care, Terminally Ill
Abstract

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.

DOI10.1016/j.jpainsymman.2016.08.011
Alternate JournalJ Pain Symptom Manage
PubMed ID27720786
PubMed Central IDPMC5385851
Grant ListR35 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

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