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Survey on Use of Palliative Radiotherapy in Hospice Care

From the Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, OH; National Hospice and Palliative Care Organization, Alexandria, VA; Department of Radiation Oncology, Toronto Regional Sunnybrook Cancer Center, Toronto, Ontario, Canada; and the Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to Stephen T. Lutz, MD, MS, Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, 15990 Medical Dr, Findlay, OH 45840; e-mail: slutz{at}bvha.org

PURPOSE: Radiation oncologists and hospice professionals both provide end-of-life care for oncology patients, and little has been written about the interface between these two groups of specialists. Hospice professionals were surveyed to assess the perceived need for palliative radiotherapy in the hospice setting, to investigate factors that limit the access of hospice patients to radiotherapy, and to suggest areas of future collaboration on education, research, and patient advocacy.

PATIENTS AND METHODS: Members of the National Hospice and Palliative Care Organization (NHPCO) and American Society for Therapeutic Radiology and Oncology jointly authored a questionnaire to investigate the beliefs of hospice professionals toward the use of radiotherapy for oncology patients in hospice. The questionnaire was distributed to all NHPCO member institutions, and the results were compiled and statistically analyzed.

RESULTS: Four hundred eighty of more than 1,800 surveyed facilities responded to the questionnaire. The findings suggest that the majority of hospice professionals feel that radiotherapy is important in palliative oncology and that radiotherapy is widely available in the United States. Yet less than 3% on average of hospice patients served by hospices responding to the survey actually received radiotherapy in 2002. The most common barriers to radiotherapy in hospice care include radiotherapy expense, transportation difficulties, short life expectancy, and educational deficiencies between the specialties.

CONCLUSION: Multiple barriers act to limit the use of palliative radiotherapy in hospice care. Finding ways to surmount these obstacles will provide opportunity for improvement in the end-of-life care of cancer patients.

Presented at the 45th Annual Meeting of the American Society for Therapeutic Radiology and Oncology, October 21, 2003, Salt Lake City, UT.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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