Tiwana Manpreet S, Barnes Mark, Kiraly Andrew, Olson Robert A
BC Cancer Agency-Centre for the North, Prince George, Canada.
University of Northern British Columbia, Prince George, Canada.
BMC Palliat Care. 2016 Jan 10;15:2. doi: 10.1186/s12904-015-0072-5.
Palliative radiotherapy (PRT) can significantly improve quality of life for patients dying of cancer with bone metastases. However, an aggressive cancer treatment near end of life is an indicator of poor-quality care. But the optimal rate of overall palliative RT use near the end of life is still unknown. We sought to determine the patterns of palliative radiation therapy (RT) utilization in patients with bone metastases towards their end of life in a population-based, publicly funded health care system.
All consecutive patients with bone metastases treated with RT between 2007 and 2011 were identified in a provincial Canadian cancer registry database. Patients were categorized as receiving RT in the last 2 weeks, 2-4 weeks, or >4 weeks before their death. Associations between RT fractionation utilization by these categories, and patient and provider characteristics were assessed through logistic regression.
Of the 16,898 courses 1734 (10.3) and 709 (4.2%) were prescribed to patients in the last 2-4 weeks and <2 weeks of their life, respectively. Primary lung (8%) and gastrointestinal (6.9%) cancers received palliative RT more commonly in the last 2 weeks of life (OR 3.72 [2.86-4.84] & 3.33 [2.42-4.58] respectively, p <0.001). Among the 709 patients who received RT in the last 2 weeks of life, 350 (49), 167 (24), and 127 (18%) were for spine, pelvis, and extremity metastases, respectively. RT was prescribed most frequently to spine (5%) and extremity (4%) metastases p <0.001 in the last two weeks of life, though only varied between 1% (sternum) and 5% (spine) by site of metastases. Single fraction RT was prescribed more commonly in the last 2 weeks of life (64.2%), compared to individuals who received RT 2-4 weeks (54.5), and >4 weeks (47.9%) before death (p <0.001).
This population-based analysis found that only 4% of patients with bone metastases received radiation therapy during the last 2 weeks of their life in our population-based, publicly funded program, though it was significantly higher in patients with lung cancer and those with metastases to the spine or extremity. Appropriately, use of multiple fractions palliative RT was less common in patients closer to death.
姑息性放疗（PRT）可显著提高死于骨转移癌患者的生活质量。然而，临终时积极的癌症治疗是低质量护理的一个指标。但临终时姑息性放疗的最佳总体使用率仍不清楚。我们试图在一个基于人群的、公共资助的医疗保健系统中，确定骨转移患者临终时姑息性放疗（RT）的使用模式。
在加拿大一个省级癌症登记数据库中，识别出2007年至2011年间接受放疗的所有连续性骨转移患者。患者被分类为在死亡前最后2周、2 - 4周或超过4周接受放疗。通过逻辑回归评估这些类别下放疗分割使用情况与患者及医疗服务提供者特征之间的关联。
在16,898个疗程中，分别有1734（10.3%）和709（4.2%）个疗程是给生命最后2 - 4周和生命最后2周内的患者开具的。原发性肺癌（8%）和胃肠道癌（6.9%）在生命最后2周接受姑息性放疗更为常见（分别为比值比3.72 [2.86 - 4.84]和3.33 [2.42 - 4.58]，p <0.001）。在生命最后2周接受放疗的709例患者中，分别有350例（49%）、167例（24%）和127例（18%）是针对脊柱、骨盆和四肢转移瘤。在生命最后两周，脊柱（5%）和四肢（4%）转移瘤的放疗处方最为频繁（p <0.001），尽管按转移部位不同仅在1%（胸骨）至5%（脊柱）之间变化。与在死亡前2 - 4周（54.5%）和超过4周（47.9%）接受放疗的个体相比，单次分割放疗在生命最后2周的患者中处方更为常见（64.2%）（p <0.001）。
这项基于人群的分析发现，在我们基于人群的公共资助项目中，只有4%的骨转移患者在生命的最后2周接受了放疗，尽管肺癌患者以及脊柱或四肢转移患者的这一比例显著更高。相应地，更接近死亡的患者较少使用多分割姑息性放疗。
