Characteristics of urgent palliative cancer care consultations encountered by radiation oncologists

Background Palliative radiation therapy (PRT) is often used in patients with advanced cancers who require urgent consultation. Objective To report on the characteristics of urgent palliative issues encountered by radiation oncologists. Methods Patterns of presentation in 162 consultations for urgent PRT at 3 centers were prospectively evaluated from May 19 to September 26, 2014. A survey of palliative care issues, including assessment of reasons for urgent consultation, disease presentation, characteristics, and sites of RT delivery, was completed by physicians and/or nurse practitioners. The response rate was 86%, with 140 of 162 responses received. Results The median age of the patients was 63 years, with 80% >= 50 years. 56% were men, and 44% were women. 57% had an Eastern Cooperative Oncology Group Performance Status of 0-1. Primary cancer diagnoses were lung (28%), breast (13%), prostate (10%), melanoma (10%), sarcoma (7%), and others (32%). The main reasons for PRT consult were pain (57%), brain metastases (29%), and cord compression (13%). The most common presenting symptoms were pain (69%), neurologic symptoms (51%), and fatigue (49%). Patients were seen throughout the trajectory of their care as follows: 63% at the time of an established metastasis, 19% at the time of their initial diagnosis continuing further cancer therapies, and 16% before hospice care without further anticancer therapy. Limitations Single institution and descriptive Conclusions PRT occurs across the spectrum of advanced cancer, from initial diagnosis to end of life, and is used in a range of urgent oncologic issues, mostly painful metastases, followed by brain metastases and cord compression. Radiation oncologists manage cancer-related symptoms such as pain, neurologic symptoms, and fatigue.