title: Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death.
abstract: Radiation therapy (RT) is used with palliative intent in patients with advanced stage cancer. Prior studies, primarily in patients with poor performance status (PS), suggest that RT is associated with aggressive medical care, which may impact patients' quality of life near death (QoD) adversely.
  
  
  
  This study examines associations between RT use and patients' receipt of aggressive care and QoD based on patients' PS.
  
  
  
  This is a multi-institutional, prospective cohort study of patients with end-stage cancers (N = 312) who were identified as terminally ill at study enrollment. RT use (n = 24; 7.7%) and Eastern Cooperative Oncology Group (ECOG) PS were assessed at study entry (median = 3.8 months before death). Aggressive care near death was operationalized as use of mechanical ventilation and/or resuscitation in the last week of life. QoD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.
  
  
  
  RT use was associated with higher QoD (8/8, 100.0%, vs. 58/114, 50.9%; P = 0.006) among patients with good PS (ECOG = 1), more aggressive care near death (3/9, 33.3%, vs. 6/107, 5.6%; P = 0.020) among patients with moderate PS (ECOG = 2), and lower QoD (1/7, 14.3%, vs. 28/51, 54.9%; P = 0.046) among patients with poor PS (ECOG = 3).
  
  
  
  Targeted use of RT in end-of-life cancer care may benefit patients with good PS, but its use may adversely affect patients with poorer PS. Decisions about RT use in this setting should consider likely end-of-life outcomes based on patients' current PS.
authors.affiliation: Department of Radiology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: David
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York, USA; Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Department of Radiation Oncology, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Josephine
authors.initials: J
authors.lastname: Kang
authors.affiliation: Department of Radiology, Weill Cornell Medical College, New York, New York, USA; Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York, USA. Electronic address: pam2056@med.cornell.edu.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D011878:Radiotherapy / Q000379:methods*; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill
keywords: Oncology; end-of-life care; quality of life; radiation therapy