Annals of palliative medicine
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Clinical Trial
STAT RT: a prospective pilot clinical trial of Scan-Plan-QA-Treat stereotactic body radiation therapy for painful osseous metastases.
Planning and treatment of bone metastases with palliative radiotherapy often requires 1-3 weeks, resulting in patient inconvenience and delayed palliation. We developed an expedited workflow that delivers palliative stereotactic body radiation therapy (SBRT) to painful bone metastases in which CT, planning, quality assurance (QA), and initial treatment are performed one day. This prospective pilot clinical trial evaluates the feasibility, safety, efficacy, and patient satisfaction of this workflow. ⋯ Results demonstrate that treating bone metastases with palliative SBRT via a multi-fraction Scan-Plan-QA-Treat patient centric workflow is feasible and safe. Although performance status, general quality of life, and opioid use were not significantly altered, patient satisfaction was high with this same-day treatment workflow.
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Review
Global palliative radiotherapy: a framework to improve access in resource-constrained settings.
Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in less-developed countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. ⋯ This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.
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Radiation oncologists play an important role in the palliative care of advanced cancer patients. The article discusses the various clinical indications of palliative radiation therapy, which include the control of bone pain, acute treatment of cord compression, the control of thoracic and gastrointestinal symptoms. ⋯ Besides prescription of radiation treatment, radiation oncologists should also function as primary palliative care providers by assessing and initial management of symptoms and other sources of distress, making prompt referrals to specialists for complex symptom management and contributing to the multidisciplinary palliative care team. Additionally, communication skills, including prognostic disclosure and goals of care discussions, should also be a core competency of radiation oncologists.
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Palliative and supportive care education for radiation oncologists in training is essential to deliver comprehensive care to patients. Surveys on palliative care education among radiation oncology program directors and residents demonstrate a disparity in formal teaching and didactics. ⋯ Future directions to improve resident education in palliative care include improving access and time dedicated to formal didactics, online and interactive modules, rotation in a palliative care service, emphasis on board examinations, and consideration of an advanced palliative care fellowship for radiation oncologists. This is the first review of the available literature reviewing formal palliative education in radiation oncology training programs in the United States.
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Cancer patients often present with several concurrent symptoms. There is evidence to suggest that related symptoms can cluster together in stable groups. The present study sought to identify symptom clusters in advanced cancer patients using the Edmonton Symptom Assessment System (ESAS) in a palliative outpatient radiotherapy clinic. ⋯ Symptom clusters were identified using three analytical methods. The following items were always in the same cluster: depression and anxiety; nausea and appetite loss; well-being and pain; tiredness and drowsiness. Further research in symptom clusters is necessary to advance our understanding of the complex symptom interactions in advanced cancer patients and to determine the most clinically relevant symptom clusters.