Hendee Sarah J, Fakhoury Kareem, Karam Sana D
Rocky Vista University, Parker, Colorado.
University of Colorado School of Medicine, Aurora, Colorado.
Adv Radiat Oncol. 2024 Aug 9;9(10):101575. doi: 10.1016/j.adro.2024.101575. eCollection 2024 Oct.
Despite the agreed-on efficacy and benefits of palliative radiation therapy (PRT) to alleviate end-of-life complications related to cancer progression, PRT remains an underused treatment in the hospice-care setting. Common barriers for hospice patient use of PRT include educational and economic limitations. This paper discussed these barriers and ways to eliminate them based on previously published interventions.
Literature search on PubMed; 30 articles were selected by the authors. All articles included are published after the year 2000 in peer reviewed journals.
Educational barriers for medical practitioners outside radiation oncology can be addressed by creating formal education programs that reduce knowledge gaps previously identified by survey-based research studies. For radiation oncologists, continued education should focus on increasing competence and comfort with end-of-life conversations and indications for use of single-fraction radiation for patients with advanced cancer. More information on radiation oncology options should be provided to patients. As for economic barriers, rapid-access programs that use advanced level practitioners can increase PRT access by the hospice population. Also, these programs can increase use of single-fraction radiation therapy (SFX RT) in patients with a shorter projected prognosis. SFX RT is beneficial in this setting because it decreases hospice expense and is as efficacious at palliating pain in patients with advanced cancer as multiple-fraction radiation.
The barriers of education and economic limitations can be addressed by: expanding the PRT curriculum for all practicing physicians, improving radiation oncologist palliative care knowledge, increasing PRT resources for patients, increasing number of rapid-access radiation therapy programs, and, when indicated, encouraging use of single-fraction radiation treatment for hospice patients.
尽管姑息性放射治疗（PRT）在缓解与癌症进展相关的临终并发症方面的疗效和益处已得到认可，但在临终关怀环境中，PRT仍然是一种未得到充分利用的治疗方法。临终关怀患者使用PRT的常见障碍包括教育和经济限制。本文基于先前发表的干预措施，讨论了这些障碍以及消除它们的方法。
在PubMed上进行文献检索；作者选择了30篇文章。所有纳入的文章均发表于2000年之后的同行评审期刊。
对于放射肿瘤学以外的医生，可通过创建正规教育项目来消除教育障碍，这些项目可减少基于调查的研究先前发现的知识差距。对于放射肿瘤学家，继续教育应侧重于提高在临终谈话方面的能力和舒适度，以及增加对晚期癌症患者使用单次分割放射治疗的适应症的了解。应向患者提供更多关于放射肿瘤学选择的信息。至于经济障碍，使用高级执业医师的快速通道项目可增加临终关怀人群对PRT的可及性。此外，这些项目可增加预计预后较短的患者对单次分割放射治疗（SFX RT）的使用。SFX RT在这种情况下有益，因为它可降低临终关怀费用，并且在缓解晚期癌症患者疼痛方面与多次分割放射治疗同样有效。
可通过以下方式解决教育和经济限制障碍：为所有执业医师扩展PRT课程，提高放射肿瘤学家的姑息治疗知识，增加患者的PRT资源，增加快速通道放射治疗项目的数量，并在适当时鼓励临终关怀患者使用单次分割放射治疗。
