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Ann Palliat Med. 2017 Aug;6(Suppl 1):S28-S38. doi: 10.21037/apm.2017.03.04. Epub 2017 Apr 15.

Radiotherapy for brain metastases near the end of life in an integrated health care system.

Author information

1
Department of Radiation Oncology, Kaiser Permanente Southern California, Los Angeles, California 90027, USA. joan.j.ryoo@kp.org.
2
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California 91101, USA.
3
Department of Radiation Oncology, Kaiser Permanente Southern California, Los Angeles, California 90027, USA.

Abstract

BACKGROUND:

To examine radiotherapy (RT) patterns-of-care and utilization at the end of life (EOL) among non-small cell lung cancer (NSCLC) patients with brain metastasis (BrM) in an integrated health care system.

METHODS:

Central tumor registry identified 5,133 patients diagnosed with NSCLC from 2007-2011. BrM were determined by imaging. Patient and clinical characteristics were obtained by chart abstraction. In addition to abstracted variables, graded prognostic assessment (GPA) score of 0-1 was derived by collected data and tested as a predictor of death within 14 or 30 days of RT.

RESULTS:

On NSCLC presentation, 10% harbored BrM while 7% developed BrM thereafter. Of 900 BrM patients, 15% were not referred for RT, with median time to death of 21 days. Median time to death for 5% not recommended RT was 48 days. Among those receiving brain RT, 11.9% died within 14 days and 23.3% (cumulatively) died within 30 days of treatment. Over 50% with GPA score 0-1 received RT, 11% within 14 days and 21% within 30 days of death; median survival of GPA score 0-1 patients was 49 days. GPA score 0-1 independently predicted for death within 30 days of RT receipt.

CONCLUSIONS:

BrM are common in NSCLC, and most patients are referred for brain RT. A surprising proportion of patients received treatment near the EOL, as 23% died within 30 days of RT. GPA score of 0-1 predicted for death within 30 days of treatment. RT referral, recommendation, and timing should be better tailored to life expectancy, and additional benchmarks for quality of care are needed.

KEYWORDS:

End of life care; metastasis; quality of care; radiotherapy (RT)

PMID:
28595434
DOI:
10.21037/apm.2017.03.04
[Indexed for MEDLINE]
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