Palliative radiotherapy: Evolving role and policy challenges

Validation of the prognostic model for palliative radiotherapy in older patients with cancer

BACKGROUND

Older patients are more likely to have a poor performance status and comorbidities. There is a reluctance to extensively investigate and treat older patients. As elderly individuals and patients with neoplasms each increase in number, palliative treatment of older patients is expected to grow as an issue.

AIM

To investigated the role of palliative radiotherapy in older patients and patients who were expected to demonstrate a therapeutic effect.

METHODS

From February 2019 to February 2022, 33 patients aged ≥ 80 years underwent palliative radiotherapy. The prognosis in palliative care study predictor (PiPS), palliative prognostic index (PPI), and delirium-palliative prognostic score (D-PaP) models were used for prognosis prediction. D-PaP scores calculated according to the doctor's prediction of clinical prediction of survival (CPS) were excluded and then analyzed for comparison. Radiation was prescribed at a dose of 2.5-7 Gy per fraction, up to a median of 39 Gy10 (range, 28-75 Gy10).

RESULTS

The median follow-up was 2.4 months (range, 0.2-27.5 months), and 28 patients (84.8%) showed subjective symptom improvements following treatment. The 2- and 6-month survival rates of all patients were 91.5% and 91.5%, respectively. According to regression analysis, the performance status index, symptom type, and radiation dose all showed no significant correlation with the treatment response. When survival was expected for > 55 days in the PiPS model, the 2-month survival rate was 94.4%. For patients with PPI and D-PaP-CPS values of 0-3.9 points, the 2-month survival rates were 90.0% and 100%, respectively. For patients with a score of ≥ 4 points, the 2-month survival rates were 37.5% and 0%, respectively.

CONCLUSION

This study shows that the prognosis prediction model used in palliative care can be used to identify patients suitable for treatment.

Radiation oncologists role, training and perceptions in palliative care: a systematic review

Aim

To assess the educational needs, role and perceptions in palliative care issues of radiation oncologists (ROs) and trainees.

Background

1/3 of radiotherapy patients are treated with palliative intent. Conversely, education and role that ROs have in the palliative care process are not well established, neither in terms of how they perceive their competence nor whether it is important to improve training, research and attention in palliative care issues at radiotherapy congresses.

Material and Methods

Literature systematic review in National Library of Medicine and Cochrane databases with 11 relevant issues to be identified. One doctor made first selection of articles, a second one confirmed their eligibility.

Results

722 articles reviewed, 19 selected. 100% recognize the importance of palliative care in radiotherapy, 89.4% the need of training in palliative care for ROs, 68.4% the necessity of improving the resident programs, 63.1% the importance of skilled ROs in palliative care, 63.1% the need of better communication skills and pain management (47.3%), 52.6%, the perception of inadequate training in palliative care, 36.8% the lack of research and palliative care topics in radiotherapy meetings, 21% the absence of adequate guidelines regarding palliative care approaches, 42.1% the importance of the ROs in palliative care teams and 26.3% the lack of their involvement.

Conclusion

Palliative care has an important role in radiotherapy but it seems ROs still need more training. It is necessary to improve training programs, increment palliative care research in radiotherapy, giving more attention to palliative care themes at radiotherapy congresses. This could lead to a better integration of radiotherapists in multidisciplinary palliative care teams in the future.

Palliative radiotherapy: what do nurses know?

BACKGROUND

palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit.

AIM

the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis.

METHODS

a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses.

FINDINGS

the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education.

CONCLUSION

nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted.

Radiotherapy for Oligometastatic Lung Cancer

Non-small cell lung cancer (NSCLC) typically presents at an advanced stage, which is often felt to be incurable, and such patients are usually treated with a palliative approach. Accumulating retrospective and prospective clinical evidence, including a recently completed randomized trial, support the existence of an oligometastatic disease state wherein select individuals with advanced NSCLC may experience historically unprecedented prolonged survival with aggressive local treatments, consisting of radiotherapy and/or surgery, to limited sites of metastatic disease. This is reflected in the most recent AJCC staging subcategorizing metastatic disease into intra-thoracic (M1a), a single extra thoracic site (M1b), and more diffuse metastases (M1c). In the field of radiation oncology, recent technological advances have allowed for the delivery of very high, potentially ablative, doses of radiotherapy to both intra- and extra-cranial disease sites, referred to as stereotactic radiosurgery and stereotactic body radiotherapy (or SABR), in much shorter time periods compared to conventional radiation and with minimal associated toxicity. At the same time, significant improvements in systemic therapy, including platinum-based doublet chemotherapy, molecular agents targeting oncogene-addicted NSCLC, and immunotherapy in the form of checkpoint inhibitors, have led to improved control of micro-metastatic disease and extended survival sparking newfound interest in combining these agents with ablative local therapies to provide additive, and in the case of radiation and immunotherapy, potentially synergistic, effects in order to further improve progression-free and overall survival. Currently, despite the tantalizing potential associated with aggressive local therapy in the setting of oligometastatic NSCLC, well-designed prospective randomized controlled trials sufficiently powered to detect and measure the possible added benefit afforded by this approach are desperately needed.