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Innovations in palliative patient care through RTT advanced practice.

Keywords: palliative radiotherapy, multidisciplinary, data collection

Aim: To present the Clinical Palliative Care Program at the radiotherapy department of the Erasmus MC for palliative patients. Goal of this program is to treat these palliative patients in the shortest possible time in order to give the patient excellent care and the best treatment. Research with the collected data from this patient population is conducted to predict outcome or overall survival after radiotherapy and will be presented.

Methods and materials: In order to facilitate the patients with metastases a Clinical Palliative Care Program with a dedicated multidisciplinary team was developed. The 1 day program for the patient starts with a consult by the radiation oncologist, is then followed by a consult with the RTT, a planning CT scan and finally the radiation treatment. Full patient care is provided by the nurse at the care post. For the data collection a medication form and the EORTC questionnaires QLQ-BM22 and OLQ-C15-PAL were used  to fill in by the patient. The radiation oncologist used a form for patient characteristics. Treatment outcome was scored in a telephone consultation on day 1 and 2 weeks after treatment by the RTT, by the radiation oncologist after 4 weeks and after 8 weeks by the nurse. Data of 896 patients with bone or brain metastases were analyzed.

Results: The Clinical Palliative Care Program is well organized and will be explained during the presentation. In the group of 734 patients with bone metastases median overall survival was 6.4 months with a large variation. On univariate analysis 10 factors were significant of which 6 factors remained significant on multivariate analysis: gender, primary tumor, morphine use, Karnofsky score, treatment options after radiotherapy and total organs metastatic. Two factors, morphine use and treatment options after radiotherapy, were not found in earlier studies. For the group of 162 patients with brain metastases treated with WBRT, the group of patients that reported to have benefit in the telephone consultation had a median survival of 8.1 months compared to 2.9 months for patients who reported no benefit from the treatment. Improvement of neurological symptoms was the most common reported benefit of the treatment.  On multivariate analysis dose dexamethasone and the possibility of treatment options after WBRT were significant. Quality of life (QoL) increased in responders, but decreased in non-responders. The mean score of the general QoL (QLQ-C15-PAL) increased 8 weeks after last fraction for the responders from score 58 to score 64, but decreased for the non-responders from score 60 to score 55.

Conclusion: The Clinical Palliative Care Program is an excellent treatment for palliative patients where they are provided with see-scan-plan-treat in 1 day. In the group of patients with bone metastases 6 significant factors were found which can prognosticate overall survival. The study on brain metastases showed that WBRT is effective in a selected group of patients: Forty nine % of the patients surviving 2 months reported benefit from the treatment resulting in a significant increased survival for this group from 2.9 to 8.1 months. The mean score of the general quality of life increased 8 weeks after last fraction for the responders, but decreased for the non-responders. For further clinical research, data analysis for this group of patients is performed to predict outcome, overall survival and quality of life to propose patients a personalized treatment.