Curative Intent Radiotherapy Delivered Within the Last Year of Life

We studied a cohort of cancer patients that underwent curative-intent radiation within the last year of life (LYOL). Given the unexpectedly short survival, we evaluated the proportion with relapsed/refractory disease, determined causes of death, and explored whether treatment intent was associated with aggressiveness of care at the end of life.

We extracted and linked claims data and radiotherapy records for patients seen at a single academic institution that died between October 1, 2014, and September 30, 2015.

Among 870 cancer patients, 290 were irradiated within the LYOL, of which 287 had treatment intent recorded (101 curative-intent, 186 palliative-intent). The majority of curative-intent patients had hematologic malignancies and/or underwent transplant (44.6%), followed by head and neck (9.9%) and gastrointestinal malignancies (9.9%). Half (n=49; 48.5%) had relapsed/refractory disease at the time of curative-intent radiation, including 13 with metastatic disease. Tumor progression (n=65; 64.4%) was the most common cause of death, followed by treatment-related mortality (n=27; 26.7%), of which transplant/hematologic malignancy patients (n=19) were the majority. Compared with palliative-intent patients, curative-intent patients had significantly higher rates of chemotherapy use within 14 days of death (P=0.04), intensive care unit stay within 30 days of death (P<0.00001), and death in the intensive care unit (P=0.001).

Cancer patients that receive curative-intent radiation in the LYOL appear to be heterogeneous and receive more aggressive care at the end of life compared with palliative-intent patients. Categorizing radiation as curative in patients with metastatic disease may reflect inappropriate decision-making among physicians. Additional studies are needed to understand how radiation oncologists categorize treatment as curative and whether prognostication models may help discriminate patients undergoing curative-intent radiation that have limited life expectancies.