Cancer: Some terminal patients receive excessive palliative radiotherapy

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A study published online April 12 in the journal Cancer has found that many patients with terminal cancer do not benefit from palliative radiation therapy despite the fact they spend much of their remaining lives undergoing treatment.

Stephan Gripp, MD, of the University Hospital Dusseldorf in Germany and colleagues reviewed the treatment of patients who were referred for palliative radiotherapy at the hospital from December 2003 to July 2004 and who died within 30 days. There were 33 such patients.

According to the authors, radiotherapy was delivered to 91 percent of those patients. Half of the patients spent more than 60 percent of their remaining lives on radiotherapy, and only 58 percent of patients were able to complete their treatments.

The authors found that many physicians overestimated the length of time their patient would survive. Among the group of patients who died within one month, physicians had estimated that 20 percent of those patients would survive for six months. In addition, while 52 percent of the patients complained that their symptoms were getting worse, pain reduction was only reported in 26 percent of patients.

The authors concluded that radiotherapy wasn’t appropriately customized to these cancer patients and that excessive radiotherapy in end-stage cancer patients may reflect overoptimistic prognoses.

"Radiation oncologists have fallen short in accurately determining the life span of terminally ill cancer patients. This has resulted in unduly prolonged radiation therapy regimens that often go uncompleted due to death or withdrawal from treatment," said Gripp.

He added that physicians need better methods for estimating how long their end-stage cancer patients will live. He also recommended that they use shorter-duration radiation schedules for palliative radiotherapy.