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Radiation Therapy in the Last Month of Life: Association With Aggressive Care at the End of Life.
Davis, Mellar P; Vanenkevort, Erin; Young, Amanda; Wojtowicz, Mark; Gupta, Mudit; Lagerman, Braxton; Liu, Edward; Mackley, Heath; Panikkar, Rajiv.
Affiliation
  • Davis MP; Department of Palliative Care (M.P.D.), Geisinger Medical Center, Danville, Pennsylvania. Electronic address: mdavis2@geisinger.edu.
  • Vanenkevort E; Department of Population and Health Science (E.V., A.Y.), Research Institute Geisinger Health System, Danville, Pennsylvania.
  • Young A; Department of Population and Health Science (E.V., A.Y.), Research Institute Geisinger Health System, Danville, Pennsylvania.
  • Wojtowicz M; Oncology Research Department (M.W.), Cancer Institute, Geisinger Medical Center, Danville, Pennsylvania.
  • Gupta M; Department of Phenomics Analytics and Clinical Data Core (M.G., B.L.), Geisinger Health System, Danville, Pennsylvania.
  • Lagerman B; Department of Phenomics Analytics and Clinical Data Core (M.G., B.L.), Geisinger Health System, Danville, Pennsylvania.
  • Liu E; Geisinger Commonwealth School of Medicine (E.L.), Danville, Pennsylvania.
  • Mackley H; Department of Radiation Oncology (H.M.), Geisinger Medical Center, Danville, Pennsylvania.
  • Panikkar R; Knapper Cancer Center, Geisinger Medical Center (R.P.), Danville, Pennsylvania.
J Pain Symptom Manage ; 66(6): 638-646, 2023 12.
Article in En | MEDLINE | ID: mdl-37657725
ABSTRACT
CONTEXT Half of the patients with cancer who undergo radiation therapy do so with palliative intent.

OBJECTIVES:

To determine the proportion of undergoing radiation in the last month of life, patient characteristics, cancer course, the type and duration of radiation, whether palliative care was involved, and the of radiation with aggressive cancer care metrics.

METHODS:

One thousand seven hundred twenty-seven patients who died of cancer between January 1, 2018, and December 31, 2019, were included. Demographics, cancer stage, palliative care referral, advance directives, use of home health care, radiation timing, and survival were collected. Type of radiation, course, and intent were reviewed. Chi-square analysis was utilized for categorical variables, and Kruskal-Wallis tests for continuous variables. A stepwise selection was used to build a Cox proportional hazard model.

RESULTS:

Two hundred thirty-three patients underwent radiation in the last month of life. Younger patients underwent radiation 67.3 years (SD 11.52) versus 69.2 years (SD 11.96). 42.6% had radiation within two weeks of death. The average fraction number was 5.5. Individuals undergoing radiation were more likely to start chemotherapy within the last 30 days of life, continue chemotherapy within two weeks of death, be admitted to the ICU, and have two or more hospitalizations or emergency room visits. Survival measured from the date of diagnosis was shorter for those undergoing radiation, 122 days (IQR 58-462) versus 474 days (IQR 225-1150). Palliative care consultations occurred later in those undergoing radiation therapy.

CONCLUSION:

Radiation therapy in the last month of life occurs in younger patients with rapidly progressive cancer, who are subject to more aggressive cancer care, and have late palliative care consults.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Terminal Care / Neoplasms Type of study: Guideline / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Pain Symptom Manage Journal subject: NEUROLOGIA / PSICOFISIOLOGIA / TERAPEUTICA Year: 2023 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Terminal Care / Neoplasms Type of study: Guideline / Prognostic_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Pain Symptom Manage Journal subject: NEUROLOGIA / PSICOFISIOLOGIA / TERAPEUTICA Year: 2023 Document type: Article