Physician-Predicted Prognosis and Palliative Radiotherapy Treatment Utilization at the End-of-Life: An Audit of a Large Cancer Center Network

Abstract Context At our institution, clinical pathways capture physicians’ prognostication of patients being evaluated for palliative radiotherapy (PRT). We hypothesize a low utilization rate of long-course RT (LCRT) and stereotactic ablative radiotherapy (SAbR) among patients seen at the end-of-life, especially those with physician predicted poor prognosis. Objective To analyze utilization rates and predictors of LCRT and SAbR at the end-of-life. Methods A retrospective review was conducted on patients who were evaluated for PRT between January 2017 to August 2019 and died within 90 days of consultation. Binary logistic regression was used to identify predictors for utilization of LCRT (≥10 fractions) and SAbR. Results A total of 1,608 patients were identified, of which 1,038 patients (64.6%) were predicted to die within a year. 693 patients (66.8%) out of 1,038 were prescribed LCRT or SAbR. On multivariate analysis, patients were less likely to be prescribed LCRT if treated at an academic site (OR 0.30; 95% CI 0.23-0.39; p Conclusion Despite most patients predicted to have a limited prognosis, LCRT and SAbR were commonly prescribed at the end-of-life.