Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy

Severity of Symptoms as an Independent Predictor of Poor Outcomes in Patients with Advanced Cancer Presenting to the Emergency Department: Secondary Analysis of a Prospective Randomized Study

Background/Objectives: Patients with advanced cancer often present to the emergency department (ED) with pain and distressing symptoms that are not systematically evaluated. The current study investigated the association of symptom severity with the diagnosis of delirium and short-term survival. Methods: In this secondary analysis of a prospective randomized study of delirium among advanced cancer patients in the ED, in which symptoms were assessed by the MD Anderson Symptom Inventory (MDASI), we analyzed the distribution of MDASI item scores by 90-day mortality (Kolmogorov-Smirnov), the association of MDASI item scores with short-term mortality (logistic regression models), and the symptoms in those with or without delirium (Mann-Whitney U test or chi-square test). Results: Of the 243 patients included, 222 (91.4%) had complete MDASI scores. The MDASI median symptom scores for pain, fatigue, and interference with work were the highest. A significant difference in MDASI item score distribution with 90-day mortality was observed for fatigue (p = 0.018), shortness of breath (p < 0.001), difficulty remembering (p = 0.038), lack of appetite (p = 0.035), drowsiness (p < 0.001), feeling sad (p = 0.031), and interference with walking (p < 0.001). In multivariable logistic regression models, shortness of breath (adjusted OR 1.15, 95% CI 1.04-1.26, p = 0.005) and drowsiness (adjusted OR 1.17, 95% CI 1.05-1.33, p = 0.008) were associated with 90-day mortality, adjusting for age, race, performance status, and cancer type. The median total MDASI score was significantly higher in patients with delirium than in those without (88, IQR 83-118 vs. 80, IQR 55-104; p < 0.001). Conclusions: Patients with advanced cancer presenting to the ED had severe symptoms, some of which were associated with shorter survival. These findings underscore the necessity of systematic symptom assessment, focusing on shortness of breath, drowsiness, fatigue, difficulty remembering, lack of appetite, feeling sad, and feeling distressed, to enhance clinical decision-making and improve the care of patients with advanced cancer. Additional longitudinal studies are needed to evaluate the improvement in symptoms and quality of life for these patients.

Audit of 30-day mortality following palliative radiotherapy: are we able to improve patient care at the end of life?

Background

Several measurements defining the expected 30-day mortality (30-DM) to use in audit of radiation oncology departments have been proposed. However, its external validity is limited because of the lack of data from non-English speaking countries. This study assessed 30-DM in patients treated with palliative radiotherapy (PRT) in a Chilean-reference radiotherapy centre and explored if there had been tailored treatment at the end of life.

Materials and methods

Retrospective data collection was carried out for all patients treated at our institution between 1st January 2018 and 31st December 2021. Individual factors were modelled first to check for univariate association with 30-DM, those variables with a significance level of < 0.05 were considered for the final multivariable model.

Results

3,357 patients were included. The most common primary malignancies were breast (22%) and lung (16.1%). The most common treatment sites were bone (47.7%) and brain (12.2%). Overall, 30-DM was 14.7%, this rate was higher in patients treated for brain metastases (25.7%) and thoracic palliation (22.1%). 30-DM was associated with poor performance status (p < 0.01), lung and esophageal-gastric cancer (p = 0.04 and p = 0.02, respectively), metastases other than bone (p < 0.01), brain metastases (p < 0.01) and private health insurance (p <0.01).

Conclusions

In patients treated for brain metastasis and thoracic palliation 30-DM was higher than suggested benchmarks. Moreover, in these groups long courses of PRT were often performed. Audit data should be useful for planning interventions that improve selection of patients and prompting review of policies for indication and fractionation schedules of PRT.

Thirty-day Mortality in Palliative Radiotherapy: A Retrospective Cohort Analysis in a Single Center

Background/Aim

Palliative radiotherapy is a critical component of cancer care aimed at symptom management and enhancing the quality of life of patients with advanced cancer. Balancing symptom relief and potential risks is pivotal in clinical decision-making. This study explored the 30-day mortality (30-DM) rate after palliative radiotherapy in a single-center setting to shed light on potential prognostic factors and safety considerations.

Patients and Methods

This retrospective cohort study included patients who underwent palliative radiotherapy for various indications between March 2020 and February 2023. Data were retrieved from electronic medical records and analyzed according to ethical guidelines. The primary outcome measure was 30-DM rate, and multivariate logistic regression analysis was conducted to identify the independent predictors of 30-DM.

Results

A total of 931 palliative radiotherapy sessions were administered to 601 patients, with a median of one session per patient. The cohort had a median age of 70 years, predominantly men (58%), and featured diverse primary cancer types, with lung cancer being the most prevalent (15.8%). The 30-DM rate was 12.9%. Multivariate analysis identified Karnofsky Performance Status (KPS) as the sole independent prognostic factor significantly associated with 30-DM.

Conclusion

This study provides valuable insights into 30-DM rates following palliative radiotherapy. Future research should focus on prospective multicenter investigations with larger cohorts and comprehensive data collection, ultimately leading to improved risk prediction models for personalized treatment decisions in palliative radiotherapy.

A Narrative of Oral Care in Palliative Patients

Painful oral conditions represent a significant problem for most patients with a serious disease and palliative care needs. The main causes of such conditions may be associated with the underlying disease and its treatment, but primarily with adverse side effects of drugs. Oral conditions can lead to worsening of the illness and reduced quality of life. The objective of this narrative is to present an overview of oral care problems of this group, including present clinical practice. The evidence base for procedures and efficient products is weak. There is therefore an obvious need for research within this field.

Associations of baseline patient-reported outcomes with treatment outcomes in advanced gastrointestinal cancer

BACKGROUND

Patient-reported outcomes (PROs) assessing quality of life (QOL) and symptom burden correlate with clinical outcomes in patients with cancer. However, to the authors' knowledge, data regarding associations between PROs and treatment response are lacking.

METHODS

The authors prospectively approached consecutive patients with advanced gastrointestinal cancer who were initiating a new treatment. Prior to treatment, patients reported their QOL (Functional Assessment of Cancer Therapy-General [FACT-G], 4 subscales: Functional, Physical, Emotional, Social; higher scores indicate better QOL) and symptom burden (Edmonton Symptom Assessment System [ESAS], Patient Health Questionnaire-4 [PHQ-4]; higher scores represent greater symptoms). Regression models were used to examine associations of baseline PROs with treatment response (clinical benefit or progressive disease [PD] at time of first scan), healthcare utilization, and survival.

RESULTS

From May 2019 to April 2020, a total of 112 patients with advanced gastrointestinal cancer were enrolled. For treatment response, 64.3% had CB and 35.7% had PD. Higher baseline ESAS-Physical (odds ratio, 1.04; P = .027) and lower FACT-G Functional (odds ratio, 0.92; P = .038) scores were associated with PD. Higher ESAS-Physical (hazard ratio [HR], 1.03; P = .044) and lower FACT-G Total (HR, 0.96; P = .005), FACT-G Physical (HR, 0.89; P < .001), and FACT-G Functional (HR, 0.87; P < .001) scores were associated with a greater hospitalization risk. Lower FACT-G Total (HR, 0.96; P = .009) and FACT-G Emotional (HR, 0.86; P = .012) scores as well as higher ESAS-Total (HR, 1.03; P = .014) and ESAS-Physical (HR, 1.04; P = .032) scores were associated with worse survival.

CONCLUSIONS

Baseline PROs are associated with treatment response in patients with advanced gastrointestinal cancer, namely physical symptoms and functional QOL, in addition to health care use and survival. The findings of the current study support the association between PROs and important clinical outcomes, including the novel finding of treatment response.