Is it necessary to do everything?

Friday, 16/04/2010  |   Cancer Process  |  no comments

Is it necessary to do everything? Is palliative radiotherapy, which should be tailored to life expectancy in end-stage cancer patients a reality or a myth? In reading this study one needs to question who is being served, the patient or the industry.

The purpose of the study was to investigate the adequacy of palliative radiation treatment in end-stage cancer patients.
Of 216 patients referred for palliative radiotherapy, 33 died within 30 days and constitute the population of the study. Symptoms, Karnofsky Performance Status (KPS), laboratory tests, and survival estimates were obtained. Treatment course was evaluated by medical records. Univariate analyses were performed by using the 2-sided chi-square test. With significant variables, multiple regression analysis was performed.
Median age was 65 years, and median survival was 15 days. Prevailing primary cancer types were lung (39%) and breast (18%). Metastases were present in 94% of patients, brain (36%), bone (24%) and lung (18%). In 91%, KPS was <50%. KPS, lactate dehydrogenase, dyspnea, leucocytosis, and brain metastases conveyed a poor prognosis. From 85 survival estimates, only 16% were correct, but 21% expected more than 6 months. Radiotherapy was delivered to 91% of patients. In 90% of radiation treatments, regimens of at least 30 Gy with fractions of 2-3 Gy were applied. Half of the patients spent greater than 60% of their remaining lifespan on therapy. In only 58% of patients was radiotherapy completed. Progressive complaints were noted in 52% and palliation in 26%.
Radiotherapy was not appropriately customised to these patients considering the median treatment time, which resembles the median survival time. About half of the patients did not benefit despite spending most of their remaining lives on therapy. Prolonged irradiation schedules probably reflect overly optimistic prognoses and unrealistic concerns about late radiation damage. Single-fraction radiotherapy was too seldom used.
Palliative radiotherapy for end-stage cancer patients is intended to control cancer-related pain and other symptoms and to help patients maintain a good quality of life when long-term cancer control is not possible. By reducing the number of cancer cells, palliative radiotherapy can ease pain, stop bleeding and relieve pressure, even when the cancer cannot be controlled. A considerable proportion of patients with terminal cancer derive no benefit from palliative radiation therapy, despite spending most of their remaining life undergoing treatments.
Gripp, S., Mjartan, S., Boelke, E. & Willers, R. Palliative radiotherapy tailored to life expectancy in end-stage cancer patients; Reality or myth? CANCER, online, April 14, 2010

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