Factors in Discontinuation of Palliative Radiotherapy


Key Points

  • Discontinuation of palliative radiotherapy was associated with a poorer performance status, a higher number of prescribed fractions, and treatment sites other than bone.
  • Discontinuation of radiotherapy was associated with poorer survival.

In a study reported by Puckett et al in the Journal of Oncology Practice, factors associated with premature discontinuation of palliative radiotherapy in cancer patients included poorer performance status, higher number of prescribed radiotherapy fractions, and treatment site other than bone metastasis.

Study Details

The study included 297 patients who began palliative radiotherapy in a multicenter radiation oncology department in 2014. Patients had a median age of 67 years and a median Karnofsky performance status score of 70; 64% were treated at an academic site, and 34% were treated at a community practice. No difference in radiation fractionation patterns between the academic practice and the community-based practice was observed (mean of 5.8 and 7.1 fractions, respectively, P = .52).

Factors in Discontinuation of Treatment

Of the 297 patients, 60 discontinued treatment early. On multivariate analysis, factors associated with discontinuation of treatment were lower Karnofsky performance status (odds ratio [OR] = 0.48 for every 10-point improvement in score, P < .001), higher number of fractions prescribed (OR = 1.07 per each unit increase, P = .005), and site other than bone metastasis (OR = 0.39 for bone vs other, P = .014).

On multivariate analysis, factors associated with poorer overall survival included discontinuation of palliative radiotherapy (hazard ratio = 3.67, P < .001), as well as a lower Karnofsky performance score, treatment at a community practice location, multiple comorbidities, and treatment of brain metastases.

The investigators concluded: “Patients with low [Karnofsky performance status] scores, long treatment courses, and those treated to sites other than bone metastasis were significantly more likely to discontinue treatment. Discontinuation was predictive for poor survival. Pretreatment evaluation of [Karnofsky performance status], comorbidities, and brain metastases can help guide appropriate patient selection for [palliative radiotherapy].”

Sewit Teckie, MD, of the Department of Radiation Medicine, Northwell Health, New York, New York, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.