Burden of Palliative Care Issues Encountered by Radiation Oncologists Caring for Patients With Advanced Cancer

Abstract

Purpose: Radiation oncologists frequently provide care for patients with advanced cancer who are in their last months or weeks of life. This study examined the previously not well characterized types and frequencies of palliative care issues encountered in consultations for palliative radiation therapy (PRT). Methods: This prospective, survey-based study assessed consecutive consults for PRT from 5/19/14 to 9/26/14 at three Boston-area, community and academic, hospital-based centers. Participating physicians and nurse practitioners completed a survey to identify and rank the relevance (5-point Likert scale, 'not at all' to 'extremely') of palliative care issues. Eight domains adapted from national palliative care guidelines – physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, and ethical and legal issues – were evaluated. 162 consecutive consultations were surveyed with 140 responses received (86% response rate). Results: Most (82%) consults had two or more palliative care domains ranked as highly (‘very’ or ‘extremely’) relevant to care. The domains of physical symptoms (91%), care coordination (70%), goals of care (59%), and psychosocial issues (52%) were the most commonly reported domains as highly relevant to care. Forty-six percent of consults involved a high palliative care burden (four or more palliative care domains identified as highly relevant to care). Predictors of high palliative care burden in multivariable analysis were ECOG performance status > 2 (OR=3.57, p=0.047), a plan for no further anti-cancer therapy after PRT (OR 3.46, p = 0.03), and a recommendation against PRT (OR 4.80, p = 0.01). Conclusions: Radiation oncology clinicians encounter multiple palliative care issues when consulting on patients for PRT. Clinicians identified physical symptoms, care coordination, and goals of care as the most relevant palliative care domains. These findings can help guide palliative care development within radiation oncology, including education and structures of care delivery.