title: Palliative radiation before hospice: the long and the short of it.
abstract: BACKGROUND
  Randomized data support shorter radiotherapy courses for management of cancer-related symptoms in the palliative setting.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the length of palliative radiotherapy before hospice enrollment among the elderly U.S. population, with a further focus on factors that influence the duration of radiation and the length of survival on hospice, including whether the duration of radiation was associated with length of survival on hospice.
  
  
  METHODS
  A total of 6982 patients with breast, prostate, lung, or colorectal cancer who received a course of radiotherapy within 30 days before hospice enrollment were identified within the Surveillance, Epidemiology, and End Results-Medicare linked database. The primary end points included the duration of palliative radiotherapy and the time from hospice enrollment through death (hospice duration). Multivariate linear regression and multivariate Cox models evaluated factors associated with the length of radiotherapy course and hospice duration.
  
  
  RESULTS
  The median length of palliative radiotherapy was 14 days, and the median hospice duration was 13 days. The course of palliative radiotherapy was longer than hospice duration in 48% of the patients. Breast and lung cancer were associated with longer courses of radiotherapy and shorter stays on hospice. Patients treated in freestanding radiation centers had longer courses of radiotherapy. For these groups, a longer radiotherapy course was not associated with longer hospice duration.
  
  
  CONCLUSIONS
  This study found relatively long courses of radiotherapy before short lengths of survival on hospice. Future research is needed to identify barriers to shorter radiotherapy courses.
authors.affiliation: Division of Palliative Medicine, Department of Internal Medicine, University of California, San Diego, La Jolla, USA.
authors.forename: Heidi N
authors.initials: HN
authors.lastname: Yeung
authors.affiliation: Division of Palliative Medicine, Department of Internal Medicine, University of California, San Diego, La Jolla, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Mitchell
authors.affiliation: Division of Palliative Medicine, Department of Internal Medicine, University of California, San Diego, La Jolla, USA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Roeland
authors.affiliation: Department of Radiation Medicine and Applied Sciences, Center for Advanced Radiotherapy Technologies, University of California, San Diego, La Jolla, USA.
authors.forename: Beibei
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Radiation Medicine and Applied Sciences, Center for Advanced Radiotherapy Technologies, University of California, San Diego, La Jolla, USA.
authors.forename: Loren K
authors.initials: LK
authors.lastname: Mell
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Department of Radiation Medicine and Applied Sciences, Center for Advanced Radiotherapy Technologies, University of California, San Diego, La Jolla, USA. Electronic address: j2murphy@ucsd.edu.
authors.forename: James D
authors.initials: JD
authors.lastname: Murphy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000628:therapy*; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000628:therapy*; D016208:Databases, Factual; D005260:Female; D017051:Hospice Care / Q000379:methods*; D006738:Hospices; D006801:Humans; D016014:Linear Models; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000379:methods*; D013997:Time Factors; D014481:United States
keywords: Palliative radiation; cancer; hospice