Palliative Radiotherapy Utilisation Within A Palliative Care Unit1

Introduction:Palliative radiotherapy (RT) has demonstrated efficacy for symptom management in advanced malignancy however concerns exist about appropriateness in deteriorating/dying patients. There are limited data available investigating the use of RT for inpatient palliative care patients. Objective:Given the lack of available evidence, vulnerability of this cohort and the potential for both benefits and harms we evaluated palliative RT utilisation amongst patients admitted to our regional Australian Palliative Care Unit (PCU).Methods:A retrospective-cohort study was undertaken incorporating all PCU inpatients between 2011 and 2016 who underwent radiotherapy. A range of clinico-demographic, radiotherapy-specific and outcome variables were collected. Opioid consumption was recorded as a surrogate for RT benefit. Comparisons in consumption were made between baseline (week before RT) and each of weeks one, two and three post RT.Results:Fifty-four episodes of RT were analysed. Pain management was the commonest reason for RT treatment, with single fractions utilised in 68% of cases with this indication. Using the proportion of patients who were able to reduce their opioid consumption following RT as a response marker, response rates were between 32-41%. The commonest discharge outcome was death with 20% and 43% of patients dying within 14 and 30 days of radiotherapy respectively. Median survival was 36 days.Conclusions:A small proportion of all PCU patients received RT with almost half dying during their admission. Response rates were lower than have been previously reported however this likely reflects, at least in part, issues with using opioid consumption as response marker. Ongoing research is required to optimise the stratification of palliative care inpatients to RT.