title: Palliative radiotherapy utilization for cancer patients at end of life in British Columbia: retrospective cohort study.
abstract: BACKGROUND
  The use of palliative radiotherapy (PRT) is variable in advanced cancer. Little is known about PRT utilization by end-of-life (EOL) cancer patients in Canada. This study examined the PRT utilization rates and factors associated with its use in a cohort of cancer patients who died in British Columbia (BC).
  
  
  METHODS
  BC residents with invasive cancer who died between April 1, 2010 and March 31, 2011 were included in the study. Their cancer registry and radiotherapy treatment records were extracted from the BC Cancer Agency information systems and linked for the analysis. The PRT utilization rates by age, sex, primary cancer diagnosis, geographic region, survival time and travel time to the cancer centre were examined. Multivariable logistic regression was used to determine the factors that influenced the PRT utilization rates.
  
  
  RESULTS
  Of the 12,300 decedents in the study 2,669 (21.7%) had received at least one course of PRT in their last year of life. The utilization rates dropped to 5.0% and 2.2% in the last 30 and 14 days of life, respectively. PRT utilization varied across diagnosis and was highest for lung cancer (45.7%) and lowest for colorectal cancer (8.9%). The rates also varied by age, survival time and travel time to the nearest radiotherapy centre. There was a greater odds of receiving PRT for those with primary lung cancer, survival time between 1.5-26 months from diagnosis or living within 2 hours from a cancer centre. The 85+ age group was least likely to receive PRT in their last year of life.
  
  
  CONCLUSIONS
  This study found PRT utilization rates of EOL cancer decedents to be variable across the province of BC. Age, diagnosis, survival time and travel time to the nearest radiotherapy centre were found to influence the odds of PRT treatment. Further work is still needed to establish the appropriate PRT utilization rates for the EOL cancer population.
authors.affiliation: School of Health Information Science, University of Victoria, PO BOX 1700 STN CSC, Victoria, British Columbia Canada.
authors.forename: Jin
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Surgery, Faculty of Medicine, University of British Columbia, 950 West 10th. Avenue, Vancouver, BC Canada ; Division of Radiation Oncology, BC Cancer Agency, Vancouver Island Centre, 2nd Floor, 2410 Lee Avenue, Victoria, BC Canada.
authors.forename: Elaine S
authors.initials: ES
authors.lastname: Wai
authors.affiliation: School of Health Information Science, University of Victoria, PO BOX 1700 STN CSC, Victoria, British Columbia Canada.
authors.forename: Francis
authors.initials: F
authors.lastname: Lau
authors.affiliation: Department of Surgery, Faculty of Medicine, University of British Columbia, 950 West 10th. Avenue, Vancouver, BC Canada ; Division of Radiation Oncology, BC Cancer Agency, Vancouver Island Centre, 2nd Floor, 2410 Lee Avenue, Victoria, BC Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Blood
keywords: End of life care; End-stage cancer; Palliative radiotherapy; Radiation therapy