Incorporating Palliative Care Improved Radiation Treatment for Bone Metastases

A novel program combining radiation oncology with palliative care increased the use of proven treatments while maintaining pain management, decreased palliative radiation use, and decreased hospital length of stay in patients with painful bone metastases, according to results presented at the 2015 American Society of Clinical Oncology (ASCO) Palliative Care in Oncology Symposium in Boston.

The Palliative Radiation Oncology Consult Service (PROC) was established in 2013, designed to provide efficient treatment by a radiation oncology team but with a focus on palliative care.

The new study examined whether the program had an effect on the use of single-fraction radiation therapy (SF-RT) and ≤ 5 fraction radiation treatment (hypo-RT), which are underutilized in spite of strong evidence of their efficacy. The study was led by Kavita Dharmarajan, MD, of Mount Sinai School of Medicine in New York.

The study included 334 patients with bone metastases; 211 were treated before PROC was instituted, and 123 were treated after PROC began. The program appeared to have an effect on the treatments, with 26% of the PROC patients receiving SF-RT courses compared with 14% of the pre-PROC patients (P = .002). Similarly, 52% of PROC patients received hypo-RT courses compared with 28% of pre-PROC patients (P = .003).

After PROC began, patients had an odds ratio (OR) for receiving SF-RT of 2.2 (95% confidence interval [CI], 1.2–3.8; P = .007), and an OR for receiving hypo-RT of 3.0 (95% CI, 1.8–4.7; P < .001).

More patients were treated as in-patients before PROC began (47% vs 33%; P = .01). The median length of stay was also significantly reduced after PROC, from 21 days to 14 days (P = .04). Thirty-nine percent of patients received palliative care services within 1 month of palliative radiation after PROC began, compared with 26% before PROC (P = .01). The pain improvement following palliative radiation was similar before and after PROC, at 81% and 84%, respectively (P = .64).

“Our study validates the importance of cohesive collaboration in cancer care,” Dharmarajan said in a press release. “When we work together, patients receive a higher quality of care that focuses on the whole person, not just a tumor.”

Don S. Dizon, MD, of Massachusetts General Hospital in Boston, moderated a press conference about the results, and agreed that the results show the importance of programs like PROC. “This study reinforces the importance of integrating palliative care throughout treatment,” he said. “The results serve as welcome evidence that we can achieve better care for patients through cooperation across disciplines.”