title: The role of radiation therapy in palliative care of children with advanced cancer: Clinical outcomes and patterns of care.
abstract: There are few published data to guide the use and timing of palliative radiation therapy (RT) in children. We aimed to determine the clinical outcomes of palliative RT in children and the relationship with palliative care and hospice referrals.
  
  
  
  A retrospective chart review was performed on all patients younger than 18 years who received palliative RT in our clinic from January 2005 to January 2015.
  
  
  
  In the specified time period, 50 children underwent 83 courses of palliative RT. Median survival after treatment was 124 days (range, 1-1141 days). Fifteen courses were delivered to children in the last 30 days of life (dol). Palliative RT was successful in 89% of courses delivered before the last 30 dol versus 28% of courses delivered in the last 30 dol (p < 0.0001, Fisher's exact test). At the time of data collection, 43 children were deceased. Altogether, 88% of children who received palliative RT were also referred to our institution's pediatric palliative care team or to hospice at some time in their course. Of the children who died, 74% were referred to hospice and 34% were on hospice while receiving palliative RT. For children not already on hospice, the median time to hospice referral was 96 days after the last fraction (range, 0-924 days).
  
  
  
  Palliative RT is effective in children with advanced cancer, although less so in the last 30 dol. With careful care coordination and multidisciplinary collaboration, RT can be successfully integrated into supportive and end-of-life care for children with advanced cancer.
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sumeeta
authors.initials: S
authors.lastname: Varma
authors.affiliation: Division of Pediatric Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Debra L
authors.initials: DL
authors.lastname: Friedman
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Stavas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017051:Hospice Care; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods*; D000070659:Patient Comfort; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D016896:Treatment Outcome
keywords: end of life; hospice; palliative care; patterns of care; radiation oncology; radiotherapy