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Thirty-day mortality as a metric for palliative radiotherapy in pediatric patients
Emily Keit1, Ronica Nanda, Peter A S Johnstone
1Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
Insights
Palliative radiotherapy (RT) may be underutilized in children. Early RT delivery improves quality of life, but late administration offers limited benefit and complicates end-of-life care planning.
Area of Science:
- Pediatric Oncology
- Palliative Care
- Radiation Oncology
Background:
- Thirty-day mortality (30DM) is a factor in adult palliative radiotherapy (RT) decisions.
- Palliative RT efficacy and ethics in pediatric end-of-life (EOL) care are not well-established.
Conclusions:
- Early palliative RT with fewer fractions (≤5) and multidisciplinary care optimizes pediatric quality of life.
- Accurate prognosis estimation and improved patient/family understanding are crucial for EOL care.
- Further research is needed to refine prognostic models and enhance patient-centered care.
Purpose Of Review:
Thirty-day mortality (30DM) is an emerging consideration for determining whether terminally ill adult patients may benefit from palliative radiotherapy (RT). However, the efficacy and ethics of delivering palliative RT at the end of life (EOL) in children are seldom discussed and not well-established.
Recent Findings:
Palliative RT is perhaps underutilized among patients ≤21 years old with rates as low as 11%. While effective when delivered early, clinical benefit decreases when administered within the last 30 days of life. Pediatric 30DM rates vary widely between institutions (0.7-30%), highlighting the need for standardized practices. Accurate prognosis estimation remains challenging and prognostic models specific to palliative pediatric patients are limited. Discordance between provider and patient/parent perceptions of prognosis further complicates decision-making.
Summary:
RT offers effective symptom control in pediatric patients when administered early. However, delivering RT within the last 30 days of life may provide limited clinical benefit and hinder optimal EOL planning and care. Early referral for palliative RT, preferably with fewer fractions (five or fewer), along with multidisciplinary supportive care, optimizes the likelihood of maintaining patients' quality of life. Prognosis estimation remains difficult, and improving patient and family understanding is crucial. Further research is needed to refine prognostic models and enhance patient-centered care.
