title: Radiation therapy at the end of life: a population-based study examining palliative treatment intensity.
abstract: BACKGROUND
  To examine factors associated with the use of radiation therapy (RT) at the end of life in patients with breast, prostate, or colorectal cancer.
  
  
  METHODS
  Using data from the Surveillance, Epidemiology, and End Results (SEER) - Medicare database, patients were over age 65 and diagnosed between January 1, 2004 and December 31, 2011 with any stage of cancer when the cause of death, as defined by SEER, was cancer; or with stage 4 cancer, who died of any cause. We employed multiple logistic regression models to identify patient and health systems factors associated with palliative radiation use.
  
  
  RESULTS
  50% of patients received RT in the last 6 months of life. RT was used less frequently in older patients and in non-Hispanic white patients. Similar patterns were observed in the last 14 days of life. Chemotherapy use in the last 6 months of life was strongly correlated with receiving RT in the last 6 months (OR 2.72, 95% CI: 2.59-2.88) and last 14 days of life (OR 1.55, 95% CI: 1.40-1.66). Patients receiving RT accrued more emergency department visits, radiographic exams and physician visits (all comparisons p < 0.0001).
  
  
  CONCLUSIONS
  Among patients with breast, colorectal, and prostate cancer, palliative RT use was common. End-of-life RT correlated with end-of-life chemotherapy use, including in the last 14 days of life, when treatment may cause increased treatment burden without improved quality of life. Research is needed optimize the role and timing of RT in palliative care.
authors.affiliation: Huron River Radiation Oncology, 5301 E Huron River Dr Ann Arbor, Michigan, 48106, USA. Marieadele.kress@gmail.com.
authors.forename: Marie-Adele Sorel
authors.initials: MA
authors.lastname: Kress
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven St, NW Suite 4000, Washington, DC, 20007, USA. Rj222@georgetown.edu.
authors.forename: Roxanne E
authors.initials: RE
authors.lastname: Jensen
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven St, NW Suite 4000, Washington, DC, 20007, USA. Ht92@georgetown.edu.
authors.forename: Huei-Ting
authors.initials: HT
authors.lastname: Tsai
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven St, NW Suite 4000, Washington, DC, 20007, USA. Tl255@georgetown.edu.
authors.forename: Tania
authors.initials: T
authors.lastname: Lobo
authors.affiliation: Huron River Radiation Oncology, 5301 E Huron River Dr Ann Arbor, Michigan, 48106, USA. AXS221@gunet.georgetown.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Satinsky
authors.affiliation: Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven St, NW Suite 4000, Washington, DC, 20007, USA. Alp49@georgetown.edu.
authors.forename: Arnold L
authors.initials: AL
authors.lastname: Potosky
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D010166:Palliative Care; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D011788:Quality of Life; D011878:Radiotherapy / Q000706:statistics & numerical data*; D018426:SEER Program; D015996:Survival Rate; D013727:Terminal Care; D014481:United States / Q000453:epidemiology