title: Routine clinical data predict survival after palliative radiotherapy: an opportunity to improve end of life care.
abstract: OBJECTIVE
  Estimating the prognosis of cancer patients with incurable disease remains an important and difficult task for clinicians. Radiotherapy is a commonly used modality for palliation of symptoms, and we investigated whether we could predict differences in overall survival after the first course of palliative radiotherapy using routinely available data.
  
  
  METHODS
  We examined variations in survival in 1226 patients after their first course of palliative radiotherapy in relation to cancer type, site treated, age, gender and socioeconomic status, and developed a multivariate model based on these.
  
  
  RESULTS
  The median overall survival after the first course of palliative radiotherapy was 5.2 months. Large differences in survival were seen, depending on the primary tumour and the site treated. Survival was much better in those with breast (median overall survival 11.4 months) or prostate cancer (8.4 months, hazard ratio = 1.3) than in those with oesophageal/gastro-oesophageal junctional tumours (4.6 months, hazard ratio = 2.3) or lung (3.9 months, hazard ratio = 2.5). The treated site was an important prognostic factor (primary tumour versus bone metastases, hazard ratio = 1.3; versus brain metastases, hazard ratio = 2.1).
  
  
  CONCLUSIONS
  The median overall survival after a first course of palliative radiotherapy was less than 6 months. Simple data, provided as part of routine radiotherapy practice, clearly discriminate between patients with very different prognoses. Such data could therefore be used to trigger appropriate end of life care.
authors.affiliation: Department of Clinical Oncology, Charing Cross Hospital, Imperial College Health NHS Trust, London, UK; Mount Vernon Cancer Centre, Northwood, London, UK; Department of Computer Science, University College London, UK. Electronic address: mhw@doctors.net.uk.
authors.forename: M
authors.initials: M
authors.lastname: Williams
authors.forename: D
authors.initials: D
authors.lastname: Woolf
authors.forename: J
authors.initials: J
authors.lastname: Dickson
authors.forename: R
authors.initials: R
authors.lastname: Hughes
authors.forename: J
authors.initials: J
authors.lastname: Maher
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D015996:Survival Rate; D013727:Terminal Care / Q000379:methods*; D006113:United Kingdom / Q000453:epidemiology
keywords: Cancer; palliative care; prognosis; radiotherapy; survival rate