Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Improving Palliative Radiotherapy
3.2. Palliative Radiotherapy Integration with Other Palliative or Supportive Treatments
3.2.1. Real World Scenarios
3.2.2. Integrating Palliative Radiotherapy in Multidisciplinary Patients Management
3.2.3. Improving Home Care and Outpatient Status by Palliative Radiotherapy
3.3. Educational Needs
3.3.1. Needs of Hospice and Palliative Medicine Physicians
3.3.2. Needs of Radiation Oncologists and Residents in Radiotherapy
4. Summary and Conclusions
Supplementary Materials
Author Contributions
Funding
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Authors, Year, Center (Ref.) | Setting | Aim | Main Findings |
---|---|---|---|
Tseng Y.D., et al., 2014, four US academic centers [20] | Online survey (102 RT care provider) | to evaluate Supportive and Palliative Radiation Oncology’s impact on PCC quality and compare PCC rating among physicians practicing with and without a dedicated PRT service | The majority of RT care providers stated that Supportive and Palliative Radiation Oncology service improves overall quality of care, communication with patients and families, team experience, time spent on technical aspects of PCC, adherence to treatment recommendations and dose/fractionation guidelines, and follow-up |
Job M., et al., 2017, Radiation Oncology Mater Center in Brisbane, Australia [23] | Palliative Advanced Practice Radiation Therapist service | to assess if Palliative Advanced Practice Radiation Therapist service improves access to PRT and reduces time from referral to treatment (48 patients were referred to the service) | Patients referred via the Palliative Advanced Practice Radiation Therapist service had a mean and median wait time of 3.5 and 3 days, respectively compared with 8.1 and 5 days for patients referred without it. Patients were also more likely to complete treatment with less visits to the hospital |
Chang S., et al., 2018, Mount Sinai Hospital [19] | Palliative Radiotherapy Department | to assess Palliative Radiation Oncology Consult service and compare outcomes between control (154 patients) and post-intervention group (296 patients), before and after the Palliative Radiation Oncology Consult service’s establishment (Observational cohort study) | After establishment of the Palliative Radiation Oncology Consult service: (1) single-fraction (RR: 7.74, 95% CI: 3.84–15.57) and hypofractionated RT (RR: 10.74, 95% CI: 5.82–19.83) was used more frequently; (2) patients required shorter hospital stays (21 vs. 26.5 median days in pre-PROC group), (3) patients were treated with more specialty-level palliative care (OR: 2.65, 95% CI: 1.56–4.49), (4) symptom control was similar (OR: 1.35, 95% CI: 0.80–2.28) |
LeGuerrier B., et al., 2019, Cross Cancer Institute in Alberta, Canada [22] | Electronic survey; PRT department | to assess palliative radiation therapists’ experience after 11 years of work in a service dedicated to PRT (7 palliative radiation therapists investigated) | Three palliative radiation therapists were involved one half-day per week for single-fraction PRT in the treatment of symptomatic bone metastases. Afterwards, the model gradually evolved to four palliative radiation therapists, five full clinic days per week |
Authors, Year, Center (Ref.) | Setting | Aim (Study Design) | Main Findings |
---|---|---|---|
Spedicato M.R., et al., 1999, Catholic University of the Sacred Heart, Rome, Italy [35] | Home care | to describe a multidisciplinary organizational model of PCC providers dealing with terminally ill patients. Home care and PRT were both managed by the same team of ROs. The team also included psychologists and nurses, with the external support from other health specialists | Holistic care and empathy in the patient’s journey is fundamental. PCC specialists play fundamental roles at every step of the way, especially when working with terminally ill patients |
Pituskin E., et al., 2010, Cross Cancer Institute, Canada [34] | Outpatient PRT clinic | to describe the impact of multidisciplinary assessment in patients with bone metastases, treated with PRT, of symptoms, medications, nutritional intake, daily life activities, and psychosocial and spiritual needs. Four weeks after RT, teleconsultation was undertaken to assess improvements (prospective) | Multidisciplinary assessment provide high number of recommendations and decreased symptom distress |
Jung H., et al., 2013, Tom Baker Cancer Centre, Canada [33] | Multidisciplinary clinic for RT and supportive care | to assess the impact of a new integrative consultation clinic of PCC, RT, and allied health professionals in 100 patients with brain metastases (Quality assurance study) | 75 patients underwent brain PRT, whereas 25 did not (main reasons: patient preference and poor performance status). End-of-life brain RT was in 9% (death within 30 days) and 1% (within 14 days) |
Nieder C., et al., 2015, Nordland Hospital, Bodø, Norway [24] | Comparison of 2 groups of patients managed by a multidisciplinary PCC team vs. oncologic staff (29 patients each) | to assess survival after early PRT in patients managed exclusively by regular oncology staff or by a multidisciplinary palliative care team in addition (Retrospective matched pairs analysis) | Median survival was not significantly different at multivariable analysis. Performance status and liver metastases were significantly correlated with survival |
Nieder C., et al., 2018, Nordland Hospital, Bodø, Norway [25] | Comparison of 2 groups of patients managed by a multidisciplinary palliative care team vs. none (36 and 65, respectively) | to analyze differences in symptom burden, baseline and outcome parameters, including completion of PRT and 30-day mortality, between PRT patients treated exclusively by regular oncology staff or a multidisciplinary palliative care team in addition (retrospective) | Failure to conclude RT was higher in the multidisciplinary palliative care team group (11 and 2%, respectively, p = 0.05), and also 30-day mortality was different (28 and 2%, respectively, p = 0.0001). Survival was not significantly different (1-year survival rates 21 and 25% respectively, p = 0.27) |
Manfrida S., et al., 2019, Catholic University of the Sacred Heart, Rome, Italy [36] | Multidisciplinary program (ROs and anesthetists) | to provide a multidisciplinary program (ROs and anesthetists) for cancer patients with pain, to assess the IMprovement in MAnagement (IM-MA study) of this symptom (retrospective) | After 4 weeks of evaluation and interventions, inadequate pain management decreased from 27.7% to 1.5%. This data was directly correlated with age (ρ = 0.0297) and performance status (ρ = 0.0137), and inversely with RT fractionation (ρ = −0.0296) |
Authors, Year, Center (Ref.) | Setting | Aim (Study Design) | Main Findings |
---|---|---|---|
Ishii K., et al., 2021, Shizuoka cancer Center [32] | Out-patients (older than 75 years) treated with PRT due to esophageal cancer-related dysphagia | to assess the duration of survival as outpatients after RT alone (retrospective) | Median survival: 14 months. Median outpatient care: 9 months |
Cellini F., et al., 2021, Catholic University of the Sacred Heart, Rome, Italy [17] | Summary of available clinical guidelines (13 papers) for PRT during COVID-19 pandemic proposed by AIRO members | to propose a clinical care model (NORMALITY) collecting available clinical guidelines for PRT during COVID-19 pandemic (systematic review) | 2 levels of telemedicine-based evaluations (triage and remote visits with possibility of images sharing) are planned to decide patient’s indication to PRT |
Authors/Year/Ref. | Setting | Aim (Study Design) | Main Findings |
---|---|---|---|
Martin et al., 2020, all US Accreditation Council on Graduate Medical Education-accredited hospice and palliative medicine fellowship programs [10] | US Accreditation Council for Graduate Medical Education accredited hospice and palliative medicine fellowship programs (19-item anonymous questionnaire) | to evaluate the need of education on PRT among hospice and palliative medicine fellows (Cross-sectional survey) | 51% did not receive any PRT education, 35% received only 1 or 2 h of PRT education, and only 14% received more than 2 h of PRT education with a rotation in RT during fellowship. 95% of participants agreed with the requirement of training in RT during hospice and palliative medicine fellowship; 96% felt that RT should be taught as a fundamental care in PCC; only 25% assessed their knowledge of RT principles as sufficient |
Martin and Jones 2020 [11] | US Accreditation Council for Graduate Medical Education-accredited hospice and palliative medicine fellowship programs | to assess the need of education on PRT among hospice and palliative medicine program directors (Cross-sectional survey) | 81 out of 120 program directors completed the survey (68% response rate). All stated the importance of a PRT curriculum in hospice and palliative medicine fellowship programs. However, PRT curriculum is absent in 30% of their programs, and only 14% have more than two hours of PRT education |
Martin et al., 2019, University of California, San Diego [9] | 5 hospice and palliative medicine fellows of a single institution participated in this course | to assess the impact of a PRT curriculum for hospice and palliative medicine fellows. The training course on PRT included 3 lessons of 1 h each and a visit to a RT service (Feasibility study) | 100% response rate; before the course, all participants stated that knowledge on PRT was fundamental, but that they were not so confident. After the course, the mean score of the objective knowledge judgment was 86%. They were also surveyed after 3 months, reporting 80% as the mean score of the objective knowledge assessment. Also their confidence on PRT increased significantly |
Authors/Year/Ref. | Setting | Aim (Study Design) | Main Findings |
---|---|---|---|
Krishnan et al., 2017, all US RT residents [14] | US RT residents | to assess training needs and experience on PCC of US RT residents to guide future palliative oncology educational interventions (Electronic survey) | 404/433 (93%) of US RT residents answered the survey; 79% of residents stated their education as “not/minimally/somewhat” adequate across all domains. Most (96%) reported PCC as an important competency within RO and 81% expressed a wish to more PCC training |
Wei et al., 2017, all US RO residency programs [15] | Directors of RT residency programs in US | to evaluate palliative supportive care and PRT training curricula in RT residency programs in US (Electronic survey) | 57/87 (63%) answered the survey. Palliative supportive care (93%) and PRT (99%) were considered as important competencies for RT residents and fellows; RT programs dedicate one or few more hours of didactics on management of (i) pain (67%), (ii) neuropathic pain (65%), (iii) nausea and vomiting (63%) |
Wei et al., 2017, all ASTRO US practicing members [16] | 4093/649 (16%) of all ASTRO US practicing members | to self-assess palliative supportive care skills and access to palliative supportive care training (Electronic survey) | 4093/649 (16%) answered to the survey. 91% of ROs defined palliative supportive care as a fundamental competency. Symptoms like pain and gastrointestinal symptoms were reported as manageable, whereas anorexia, anxiety, and depression were reported as difficult to control; 42% of ROs do not receive any further palliative supportive care education beyond their residency training |
Lo Presti et al., 2020, NA [12] | Literature review (19 paper extracted about ROs role, perceptions and education in PCC) | to report available literature data on role, perception and training needs in PCC of both ROs and trainees (Systematic review) | 100% of all papers reported as fundamental the role of PCC in RT and: (i) need of education in PCC for ROs (89.4%); (ii) need of PCC in resident programs (68.4%); (iii) importance of trained ROs in PCC (63.1%); (iv) perception of inadequate training in PCC (52.6%); (v) need of skills in communication (63.1%) and pain management (47.3%); (vi) lack of research and PCC topics in RT meetings (36.8%); (vii) lack of guidelines on PCC approaches (21%) |
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Scirocco, E.; Cellini, F.; Donati, C.M.; Capuccini, J.; Rossi, R.; Buwenge, M.; Montanari, L.; Maltoni, M.; Morganti, A.G. Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review. Curr. Oncol. 2022, 29, 7932-7942. https://doi.org/10.3390/curroncol29100627
Scirocco E, Cellini F, Donati CM, Capuccini J, Rossi R, Buwenge M, Montanari L, Maltoni M, Morganti AG. Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review. Current Oncology. 2022; 29(10):7932-7942. https://doi.org/10.3390/curroncol29100627
Chicago/Turabian StyleScirocco, Erica, Francesco Cellini, Costanza Maria Donati, Jenny Capuccini, Romina Rossi, Milly Buwenge, Luigi Montanari, Marco Maltoni, and Alessio Giuseppe Morganti. 2022. "Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review" Current Oncology 29, no. 10: 7932-7942. https://doi.org/10.3390/curroncol29100627
APA StyleScirocco, E., Cellini, F., Donati, C. M., Capuccini, J., Rossi, R., Buwenge, M., Montanari, L., Maltoni, M., & Morganti, A. G. (2022). Improving the Integration between Palliative Radiotherapy and Supportive Care: A Narrative Review. Current Oncology, 29(10), 7932-7942. https://doi.org/10.3390/curroncol29100627