1 Department of Radiation Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
J Palliat Med. 2014 Jun;17(6):662-6. doi: 10.1089/jpm.2013.0549. Epub 2014 Mar 27.
The development of brain metastases is a common cause of morbidity and mortality in cancer patients. Limited life expectancy is well established once a patient requires whole-brain radiotherapy (WBRT). There is emerging evidence demonstrating the value of involving palliative care services alongside traditional treatments. However, data regarding the utilization of these services in patients requiring WBRT remain unexplored.
Patients with histologic or radiographic evidence of brain metastases treated with WBRT alone between July 2010 and June 2012 were reviewed retrospectively. Patient demographics, the number of hospital admissions in the last 6 months of life, survival, and referrals to palliative care services were evaluated.
Ninety-eight patients were diagnosed with brain metastases and treated with WBRT alone. The median overall survival following WBRT was 80 days. Twenty-eight of the patients presented to the emergency department ≥2 times in the last 6 months of life. Sixty-eight percent of patients were referred to palliative care. Of those referrals, 57% were during an inpatient hospitalization. The median survival from palliative care referral to death was 27 days.
Patients with brain metastasis requiring WBRT have a predictable dying trajectory. These patients are likely to have a high symptom burden and would benefit from palliative care. Timely palliative care referrals in this population remain inadequate and classically follow a hospital admission. Referrals continued to be late in the dying process and the recommendation for WBRT can be used as an independent marker for initiating end-of-life discussions and involving palliative care.
脑转移的发展是癌症患者发病率和死亡率的常见原因。一旦患者需要全脑放疗（WBRT），预期寿命就会受到限制。有新的证据表明，在传统治疗的基础上引入姑息治疗服务具有价值。然而，关于需要 WBRT 的患者使用这些服务的数据仍未得到探索。
回顾性分析了 2010 年 7 月至 2012 年 6 月期间单独接受 WBRT 治疗的有组织学或影像学证据显示脑转移的患者。评估了患者的人口统计学数据、生命最后 6 个月的住院次数、生存情况以及向姑息治疗服务的转介情况。
98 例患者被诊断为脑转移，并单独接受 WBRT 治疗。WBRT 后总生存中位数为 80 天。28 例患者在生命的最后 6 个月中至少 2 次到急诊科就诊。68%的患者被转介至姑息治疗。在这些转介中，57%是在住院期间进行的。从姑息治疗转介到死亡的中位生存时间为 27 天。
需要 WBRT 的脑转移患者具有可预测的临终轨迹。这些患者可能有较高的症状负担，将受益于姑息治疗。在该人群中，及时进行姑息治疗转介仍然不足，传统上是在住院后进行。转介仍在临终过程中较晚进行，并且推荐进行 WBRT 可作为启动临终讨论和引入姑息治疗的独立标志物。
