Background With timely integration of palliative care alongside oncology management, needs of patients are met in a more coherent approach challenging the misperception that there is transition point to palliative care. Therefore the project aimed to understand the timing of radiotherapy in relation to death and inform the clinical decision making regarding the appropriateness of radiotherapy for these patients.
Methods Retrospective case-note review of patient records over a 1 year period (January 2017 to January 2018) who had received radiotherapy with a diagnosis of a lung cancer.
Results 86 patient were identified and the majority had a diagnosis of lung cancer(97%) with the patients having radiotherapy to their primary lung lesion (35%), bone metastases (35%), for malignant spinal cord compression(14%) and brain metastases(9%) mainly. 36% of patients had a performance status (PS) of between 0–1, 44% having a PS of 2 and then 12% having PS3-4. Interestingly 10% of patient had no PS recorded. 32% of patients had one fraction of treatment with 67% having a fractionated regimen ranging from 3–12 treatments. 16% of patients died within 30 days having had their treatment and a further 15% within 59 days with 55% of those patients having had fractionated regimens (Range 5–12).
Conclusions This project highlights that PS is not always recorded for patient but still a key indicator on the appropriateness of radiotherapy. Given the debate about timing and then effectiveness of radiotherapy and proximity to death, a considerable proportion of patients are having a fractionated regimen before gaining optimal effect of the their treatment. Therefore PS coupled with some understanding of prognosis may help in deciding whether a single high dose fraction maybe more advantageous for the patient than a prolonged fractionation regimen in supporting their symptoms.
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