Assessing the utilization of radiotherapy near end of life at a Finnish University Hospital: a retrospective cohort study.
Acta Oncol
; 56(10): 1265-1271, 2017 Oct.
Article
in En
| MEDLINE
| ID: mdl-28503990
ABSTRACT
BACKGROUND:
Palliative radiotherapy can improve quality of life for cancer patients during the last months of life. However, very short life expectancy may devastate the benefit of the treatment. This single center study assesses the utilization of radiotherapy during the last weeks of life. MATERIAL ANDMETHODS:
All cancer patients (N = 38,982) treated with radiotherapy (N = 11,395) in Turku University Central Hospital during 2005-2013 were identified in the database consisting of electronic patient records. One fourth (N = 2904, 25.5%) of the radiotherapy treatments were given during the last year of life. The last radiotherapy treatments and the time from the last radiotherapy treatment to death were assessed in regards to patients' age, cancer diagnosis, domicile, place of death and the treatment year. Treatments given during the last two weeks of life were also assessed regarding the goal of treatment and the reason for possible discontinuation.RESULTS:
The median time from the last fraction of radiotherapy to death was 84 d. During the last two weeks before death (N = 340), pain (29.4%) was the most common indication for radiotherapy. Treatment was discontinued in 40.6% of the patients during the last two weeks of life, and worsening of general condition was the most common reason for discontinuity (70.3%). The patients receiving radiotherapy during the last weeks of life were more likely to die in tertiary care unit. During the last year of life single-fraction treatment was used only in 7% of all therapy courses. There was a statistically significant (p < .05) decrease in the median number of fractions in the last radiotherapy treatment between 2005-2007 (8 fractions) and 2011-2013 (6 fractions).CONCLUSIONS:
Up to 70% of the treatments during the last two weeks of life were not delivered to alleviate pain and utilization of single fraction radiotherapy during the last year of life was infrequent. These observations suggest that practice of radiotherapy during the last weeks of life should be revisited.
Full text:
1
Database:
MEDLINE
Main subject:
Terminal Care
/
Neoplasms
Type of study:
Etiology_studies
/
Observational_studies
Limits:
Humans
Country/Region as subject:
Europa
Language:
En
Journal:
Acta Oncol
Journal subject:
NEOPLASIAS
Year:
2017
Type:
Article
Affiliation country:
Finland