New Model Supports Use of Palliative Care With Radiotherapy for Bone Metastases

Don Dizon, MD

A novel service model that incorporated palliative care measures and shorter radiation treatment was associated with fewer unfinished treatments with radiation, shorter hospital stays, and increased use of palliative care for patients with bone metastases, according to preliminary findings from a study presented at the 2015 Palliative Care in Oncology Symposium.

“This is important work and it demonstrates first-hand the practical impact incorporating palliative care can have to standard treatment,” said ASCO expert Don S. Dizon, MD, clinical co-director of Gynecologic Oncology at Massachusetts General Hospital Cancer Center, said during a presscast when the results were presented.

The study looked at 336 patients with stage IV cancer receiving radiation treatment for bone metastases. From December 2010 to September 2013, 175 patients received standard care and from October 2013 to September 2015, 161 patients received care under the new model.

The novel service model called for increased use of single-fraction radiation treatment and fraction radiation treatments given over the course of 1 week or less. In the study, patients receiving ≤5 fewer radiation treatments increased from 26% to 61%.

The new service model also included whole-patient assessments and family meetings. During these encounters, a careful evaluation of patients’ physical symptoms, as well as psychosocial, spiritual, lifestyle, and logistical concerns, was performed.

In addition to radiation oncologists, medical oncologists and palliative care specialists, family meetings could include representatives from social work, nursing, chaplaincy, and family members, all of whom play vital roles in a patient’s decision-making.

Use of shorter radiation treatments under the new model was associated with an increase in the proportion of patients receiving palliative care within a month (49% vs 34%). The new model also led to a decrease in patients’ median length of stay (18 vs 12 days) and a reduction in the proportion of unfinished radiation treatments (15% vs 8%).

“Partnering with palliative care helps us incorporate goals and preferences into our care plans,” said the study’s senior author, Kavita Dharmarajan, MD, an assistant professor of Radiation Oncology and Palliative Medicine at Mount Sinai Medical Center. “When we work together, patients receive a higher quality of care that focuses on the whole person, not just a tumor.”

Importantly, changes in care under the new model did not affect the ability to relieve pain—80% of patients achieved pain relief under the new model compared with 74% under the old model, though the difference was not statistically significant.

“It’s possible not only to tailor our treatment for patients with bone metastases, leading to better utilization of resources and higher completions of therapy, but we can do so without negatively impacting the goals of treatment in the first place,” Dizon said.

The standard treatment for bone metastases is 10 radiation treatments, said Dharmarajan. Occasionally, Dharmarajan noted, patients do not survive long enough following radiation to experience its benefits. Shorter treatment is as effective but is currently underutilized.

During the presscast, Dharmarajan told the story of “Mrs. Jones,” a 48-year-old patient with advanced breast cancer who was admitted with severe back pain from metastases to her spine. As the mother of 2 teenage boys, her goals were to spend as much time with them as possible and live as long as possible.

Had she received care by the palliative/radiation intervention, Dharmarajan says, Jones would have been most likely referred to palliative care services, her pain would have most likely been controlled, and she would have been able to spend 6 more days at home with her sons.

“When we work together, patients receive a higher quality of care that focuses on the whole person, not just a tumor,” Dharmarajan said.

Chang S, Smith CB, Morrison S, et al. A palliative radiation oncology consult service’s impact on care of advanced cancer patients with symptomatic bone metastases. J Clin Oncol 33, 2015 (suppl 29S; abstr 110).