Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis

Ian Fraser; Shilo Lefresne; Jacqueline Regan; Eric Berthelet; Negar Chooback; Cheryl Ho; Robert Olson

doi:10.1016/j.lungcan.2019.02.024

Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis

Lung Cancer. 2019 Sep:135:97-103. doi: 10.1016/j.lungcan.2019.02.024. Epub 2019 Feb 22.

Authors

Ian Fraser¹, Shilo Lefresne¹, Jacqueline Regan², Eric Berthelet¹, Negar Chooback³, Cheryl Ho³, Robert Olson⁴

Affiliations

¹ Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada; Radiation Therapy Program, BC Cancer - Vancouver, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada.
² Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada.
³ Medical Oncology Program, BC Cancer - Vancouver, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, British Columbia, V5Z 1M9, Canada.
⁴ Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, British Columbia, V5Z 1M9, Canada; Radiation Therapy Program, BC Cancer - Prince George (Centre for the North), 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada. Electronic address: Rolson2@bccancer.bc.ca.

PMID: 31447009
DOI: 10.1016/j.lungcan.2019.02.024

Abstract

Objectives: Palliative thoracic radiotherapy (RT) can improve quality of life for patients with advanced lung cancer, but treatment can be associated with acute toxicity and symptomatic relief may take several weeks. The optimal fractionation schedule is not known. Delivery of RT near the end of life (EOL) is an emerging indicator of poor quality care. The aim of this study was to determine utilization of palliative thoracic RT in the last 4 weeks of life, and factors associated with its use, in patients with incurable lung cancer in a population-based healthcare system.

Materials and methods: All patients with lung cancer in British Columbia treated with palliative thoracic RT in 2014 and 2015 were identified. Associations between starting a course of palliative thoracic RT within 4 weeks of death and patient/treatment characteristics were assessed using univariate and multivariate logistic regression analysis.

Results: 1676 courses of palliative thoracic RT were delivered to 1584 lung cancer patients. Median survival was 20 weeks. 12% of palliative thoracic RT courses were delivered in the last 4 weeks of life, with short fractionation schedules and simple RT planning techniques used more frequently near EOL. Of RT courses delivered in the last 4 weeks of life 89% were courses of 1 - 5 fractions, 75% were completed as prescribed and 94% involved simple 1-2 field RT techniques. Receipt of RT in the last 4 weeks of life was associated with male gender, younger age, poor performance status, metastatic disease, small cell carcinoma histology and no prior chemotherapy.

Conclusion: Further study and standardization of quality indicators for palliative RT utilization near EOL is required. Whilst clarification occurs, physicians should consider the prognosis of patients with incurable lung cancer and the realistic expectation of benefit from palliative thoracic RT when considering treatment indications and fractionation schedules.

Keywords: End of life; Lung cancer; Palliative; Radiotherapy; Thoracic.

MeSH terms

Adult
Aged
Aged, 80 and over
Female
Humans
Lung Neoplasms / diagnosis
Lung Neoplasms / epidemiology*
Lung Neoplasms / mortality
Lung Neoplasms / radiotherapy*
Male
Middle Aged
Palliative Care*
Population Surveillance
Prognosis
Radiotherapy Dosage
Radiotherapy, Adjuvant
Terminal Care*
Treatment Outcome