Older patients and those with comorbid conditions are less likely to receive palliative radiotherapy, according to an analysis of data from 51,610 patients with stage IV breast, prostate, lung, or colorectal cancer. The study also found that black patients with prostate cancer were 20% less likely than white patients to receive palliative radiotherapy (P < .001) and black patients with colorectal cancer were 28% less likely (P < .001) to receive palliative radiotherapy. “Understanding these patterns of care, along with further research into the underlying causes, will improve access and quality of palliative [radiotherapy],” the investigators stated.
Patients were identified using the Surveillance, Epidemiology, and End Results–Medicare linked database. Palliative radiotherapy had been administered to 41% of the total, including 53% of patients with lung cancer, 42% of patients with breast cancer, 40% of patients with prostate cancer, and 12% of patients with colorectal cancer. “Among those with lung, breast, or prostate cancer, there were higher rates of palliative [radiotherapy] in higher socioeconomic classes and among people who were married,” the authors noted.
A significant number of patients died within 2 weeks of completing radiotherapy, including 23% of patients with lung cancer, 12% of patients with colorectal cancer, 11% of patients with breast cancer, and 8% of patients with prostate cancer. “In addition to tumor site, significant predictors (P < .05) of death within 2 weeks of receiving [radiotherapy] included increased age, increased comorbidity, and male sex,” the researchers reported.
Identifying and understanding why patients sometimes receive radiotherapy within the last few weeks of their lives “poses a challenge, given that the timing of radiotherapy depends on multiple factors,” the authors wrote. “Although earlier patient identification and referral to a radiation oncologist could help, this approach may not be feasible in all patients, given their relatively short overall survival. Physicians consistently overestimate survival in patients with cancer at the end of life, and improved prognostic tools or biomarkers could lead to enhanced patient selection. In addition, improvements in the delivery of radiation therapy, such as faster times from referral to treatment or shorter courses of palliative [radiotherapy] would effectively lengthen the interval between [radiotherapy] and death. Further research is desperately needed to better understand this complicated issue.” ■
Murphy JD, et al: J Oncol Pract. April 16, 2013 (early release online).