October 5, 2015
Palliative care focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. It also provides comprehensive support to people living with cancer and their family, friends, and caregivers. At Mount Sinai Medical Center in New York, doctors are trying an innovative new approach to caring for patients with advanced cancer who need radiation therapy, typically for cancer that has spread. In this approach, patients are evaluated by both radiation oncologists and specialists in palliative care.
Family meetings and patient assessments are an important part of this new approach. These meetings help doctors evaluate a patient’s social, emotional, spiritual, and lifestyle concerns, in addition to his or her physical symptoms. During these meetings, doctors, patients, and family members and caregivers discuss the overall goals of treatment. Other professionals, such as social workers, nurses, and religious advisors may also be involved in these meetings.
At Mount Sinai, this approach is available for patients with any type of cancer who need radiation therapy for side effects, usually for cancer that has spread. However, the study discussed here focuses on patients who received radiation therapy to reduce pain from cancer that has spread to the bone.
To find out whether this new approach was improving patient care, researchers analyzed information from patients with cancer that spread to the bone who had received radiation therapy. Of these patients, 175 received radiation therapy before the new approach was started, and 161 received radiation therapy after the approach was started.
Researchers found that combining palliative care with radiation oncology resulted in shorter radiation therapy schedules. And, the shorter schedules were equally effective at controlling patients’ level of pain. Previous radiation therapy schedules for controlling bone pain lasted 2 weeks or more, leaving some patients unable to finish the full treatment because of their health. Combining radiation oncology and palliative care also increased the use of shorter schedules, such as radiation therapy given in a single session or for 1 week or less.
Researchers found that these shorter radiation therapy schedules had several benefits for patients, such as:
Shorter hospital stays: from about 18 days before the new approach to about 12 days after,
Half as many unfinished radiation therapy treatments: 15% before compared with 8% after, and
More patients receiving palliative care services within a month of finishing treatment: 34% before compared with 49% after.
What this means for patients
“Our study validates the importance of collaboration in cancer care. As a palliative radiation oncologist, tackling pain is only a small part of what I do. My role extends to engage patients and families in conversations that help distill their priorities and set realistic expectations of treatment. Partnering with palliative care helps us incorporate goals and preferences into our care plans,” said the study’s senior author Kavita Dharmarajan, MD, an assistant professor of radiation oncology and palliative medicine at Mount Sinai Medical Center. “When we work together, patients receive a higher quality of care that focuses on the whole person, not just a tumor.”
In this study, the use of shorter radiation therapy schedules increased the amount of time patients were able to stay out of the hospital. According to the authors, most patients appreciate more time at home, and the support they received from palliative care services allowed patients and families to manage symptoms at home.
Questions to ask your doctor
What stage of cancer do I have? Has it spread to the bone?
If I have bone pain from cancer, what can be done to help manage the pain?
Who will be involved in managing my side effects? Is there a palliative care specialist I can meet with?
What physical, emotional, and social factors should we consider when discussing my options for managing side effects?