Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death

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• 作者：David Li ; MD ; PhD^a ; Holly G. Prigerson ; PhD^b ; ^c ; Josephine Kang ; MD ; PhD^d ; Paul K. Maciejewski ; PhD^a ; ^c ; ^{pam2056@med.cornell.edu}
• 关键词：Oncology ; radiation therapy ; end-of-life care ; quality of life
• 刊名：Journal of Pain and Symptom Management
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：53
• 期：1
• 页码：25-32
• 全文大小：158 K
• 卷排序：53

文摘

Radiation therapy (RT) is used with palliative intent in patients with advanced stage cancer. Prior studies, primarily in patients with poor performance status (PS), suggest that RT is associated with aggressive medical care, which may impact patients' quality of life near death (QoD) adversely.ObjectiveThis study examines associations between RT use and patients' receipt of aggressive care and QoD based on patients' PS.MethodsThis is a multi-institutional, prospective cohort study of patients with end-stage cancers (N = 312) who were identified as terminally ill at study enrollment. RT use (n = 24; 7.7%) and Eastern Cooperative Oncology Group (ECOG) PS were assessed at study entry (median = 3.8 months before death). Aggressive care near death was operationalized as use of mechanical ventilation and/or resuscitation in the last week of life. QoD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.ResultsRT use was associated with higher QoD (8/8, 100.0%, vs. 58/114, 50.9%; P = 0.006) among patients with good PS (ECOG = 1), more aggressive care near death (3/9, 33.3%, vs. 6/107, 5.6%; P = 0.020) among patients with moderate PS (ECOG = 2), and lower QoD (1/7, 14.3%, vs. 28/51, 54.9%; P = 0.046) among patients with poor PS (ECOG = 3).ConclusionsTargeted use of RT in end-of-life cancer care may benefit patients with good PS, but its use may adversely affect patients with poorer PS. Decisions about RT use in this setting should consider likely end-of-life outcomes based on patients' current PS.