title: Incorporation of life expectancy estimates in the treatment of palliative care patients receiving radiotherapy: treatment approaches in light of incomplete prognostic models.
abstract: Physician estimates of patients' survival times have historically been inaccurate. In particular, physicians have often been overly optimistic in their predictions. Our review begins by documenting some of the literature addressing these concerns and proceeds to a discussion of prognostic models that have been created to aid physicians in providing more accurate estimates. We then discuss new findings showing survival to be influenced by particular treatment factors. Given such findings, currently existing prognostic models are now incomplete. However, with the abundance of evidence-based treatment options in a wide variety of patient populations, we propose that radiation oncologists need no longer rely so heavily on the precise prognostic capacity of survival models. Patients of different age demographics and survival prognoses benefit from palliative radiation treatment. More specifically, our report documents studies which show that for uncomplicated bone metastases, a single 8 Gy fraction of radiation is an equally effective tool for palliation regardless of whether a patient will have a short or long duration of survival. In addition we discuss evidence-based treatment options for patients with complicated bone metastases, lung and brain metastases. Further research is required to incorporate treatment factors in future survival prediction models.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Chiu
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Leonard
authors.initials: L
authors.lastname: Chiu
authors.affiliation: Department of Radiation Oncology, Blanchard Valley Regional Cancer Center, Findlay, Ohio, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lutz
authors.affiliation: Liaoning Cancer Hospital & Institute, Shenyang 110042, China.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Breanne
authors.initials: B
authors.lastname: Lechner
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Pulenzas
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Marko
authors.initials: M
authors.lastname: Popovic
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Carlo
authors.initials: C
authors.lastname: DeAngelis
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Milica
authors.initials: M
authors.lastname: Milakovic
authors.affiliation: Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Chow
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada. Edward.Chow@sunnybrook.ca.
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
mesh_terms: D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary; D019317:Evidence-Based Medicine; D006801:Humans; D008017:Life Expectancy; D008962:Models, Theoretical; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D011829:Radiation Dosage
keywords: Radiotherapy; palliative; prognosis; survival