• J Pain Symptom Manage · Aug 2021

    Patterns of Specialty Palliative Care Utilization Among Patients Receiving Palliative Radiotherapy.

    • Jie Jane Chen, Bhupendra Rawal, Monica S Krishnan, Lauren M Hertan, Diana D Shi, Claudia S Roldan, Mai Anh Huynh, Alexander Spektor, and Tracy A Balboni.
    • Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Cancer Center, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
    • J Pain Symptom Manage. 2021 Aug 1; 62 (2): 242-251.

    ContextPalliative radiation therapy (RT) is frequently used to ameliorate cancer-associated symptoms and improve quality of life.ObjectivesTo examine how palliative care (PC) as a specialty is integrated at the time of RT consultation for patients with advanced cancer.MethodsWe retrospectively reviewed 162 patients with metastatic cancer who received palliative RT at our institution (7/2017-2/2018). Fisher's exact test identified differences in incidence of receiving any specialty PC. Logistic regression analyses determined predictors of receiving PC.ResultsOf the 74 patients (46%) who received any specialty PC, 24 (32%) initiated PC within four weeks of RT consultation. The most common reasons for specialty PC initiation were pain (64%) and goals of care/end-of-life care management (23%). Referrals to specialty PC were made by inpatient care teams (48.6%), medical oncologists (48.6%), radiation oncologists (1.4%), and self-referring patients (1.4%). Patients with pain at RT consultation had a higher incidence of receiving specialty PC (58.7% vs. 37.4%, P = 0.0097). There was a trend toward decreased PC among patients presenting with neurological symptoms (34.8% vs. 50%, P = 0.084). On multivariable analysis, receiving specialty PC significantly differed by race (non-white vs. white, odds ratio [OR] = 6.295 [95% CI 1.951-20.313], P = 0.002), cancer type (lung vs. other histology, OR = 0.174 [95% CI 0.071-0.426], P = 0.0006), and RT consultation setting (inpatient vs. outpatient, OR = 3.453 [95% CI 1.427-8.361], P = 0.006).ConclusionFewer than half of patients receiving palliative RT utilized specialty PC. Initiatives are needed to increase PC, especially for patients with lung cancer and neurological symptoms, and to empower radiation oncologists to refer patients to specialty PC.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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