Pain as a Reason and Presentation Among Urgent Palliative Radiation Oncology Consultations
Muhammad Fareed, Clinical Fellow in Supportive and Palliative Radiation Oncology, Brigham and Women's Cancer Center, Harvard Medical School
Background: Palliative radiation therapy (PRT) is often used in patients with advanced cancers who require urgent consultation. We reported on the types, frequencies, and characteristics of urgent palliative care issues encountered by radiation oncology clinicians, including pain management and spiritual needs.
Methods: Patterns of presentation in 162 consultations for urgent PRT at 3 centers were prospectively evaluated from May 19 to September 26, 2014. A survey on the assessment of reasons for urgent PRT consultation, disease presentation, characteristics and sites of RT delivery was completed by physicians and/or nurse practitioners. Palliative care issues relevant to the radiation oncologist’s management of the patient were also assessed. Domains assessed were adapted from national palliative care guidelines – physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, and ethical and legal issues.
Results: The response rate was 86%, with 140 of 162 responses received. The median age of the patients was 63 years, with 80% older than 50 years. 56% were men, and 44% were women. 57% had an Eastern Cooperative Oncology Group Performance Status of 0-1. Primary cancer diagnoses were lung (28%), breast (13%), prostate (10%), melanoma (10%), sarcoma (7%), and others (32%). The main reasons for PRT consult were: pain (57%), brain metastases (29%), and cord compression (13%). The most common presenting symptoms were a pain (69%), neurologic symptoms (51%), and fatigue (49%). Patients were seen throughout the trajectory of their care as follows: 63% at the time of an established metastasis, 19% at the time of their initial diagnosis continuing further cancer therapies, and 16% before hospice care without further anticancer therapy. The palliative care issues radiation oncologists managed as part of the PRT consultation included: physical symptoms (91%), care coordination (70%), goals of care (59%), and psychosocial issues (52%), advanced care planning (29%), cultural considerations (12%), spiritual needs (10%), and ethical and legal issues (7%). Just over half of patients (51%) with spiritual issues deemed relevant to the radiation oncologists’ care also had pain management issues relevant to care. Of all patients presenting with pain management needs, 26 % of patients had spiritual needs that needed management.
Conclusions: Pain is the predominant reason among patients seen by radiation oncologists for urgent PRT consultations. Of patients presenting with pain, over a quarter required simultaneous consideration of spiritual needs as part of the radiation oncologist’s management. Among patients with spiritual needs requiring attention, over half had pain management needs. Though these assessments of spiritual issues by clinicians likely greatly underestimates the frequency of patient spiritual needs, the findings do point to the frequent need for clinicians to manage spiritual and pain needs concomitantly in the urgent care setting.
Methods: Patterns of presentation in 162 consultations for urgent PRT at 3 centers were prospectively evaluated from May 19 to September 26, 2014. A survey on the assessment of reasons for urgent PRT consultation, disease presentation, characteristics and sites of RT delivery was completed by physicians and/or nurse practitioners. Palliative care issues relevant to the radiation oncologist’s management of the patient were also assessed. Domains assessed were adapted from national palliative care guidelines – physical symptoms, psychosocial issues, cultural considerations, spiritual needs, care coordination, advance care planning, goals of care, and ethical and legal issues.
Results: The response rate was 86%, with 140 of 162 responses received. The median age of the patients was 63 years, with 80% older than 50 years. 56% were men, and 44% were women. 57% had an Eastern Cooperative Oncology Group Performance Status of 0-1. Primary cancer diagnoses were lung (28%), breast (13%), prostate (10%), melanoma (10%), sarcoma (7%), and others (32%). The main reasons for PRT consult were: pain (57%), brain metastases (29%), and cord compression (13%). The most common presenting symptoms were a pain (69%), neurologic symptoms (51%), and fatigue (49%). Patients were seen throughout the trajectory of their care as follows: 63% at the time of an established metastasis, 19% at the time of their initial diagnosis continuing further cancer therapies, and 16% before hospice care without further anticancer therapy. The palliative care issues radiation oncologists managed as part of the PRT consultation included: physical symptoms (91%), care coordination (70%), goals of care (59%), and psychosocial issues (52%), advanced care planning (29%), cultural considerations (12%), spiritual needs (10%), and ethical and legal issues (7%). Just over half of patients (51%) with spiritual issues deemed relevant to the radiation oncologists’ care also had pain management issues relevant to care. Of all patients presenting with pain management needs, 26 % of patients had spiritual needs that needed management.
Conclusions: Pain is the predominant reason among patients seen by radiation oncologists for urgent PRT consultations. Of patients presenting with pain, over a quarter required simultaneous consideration of spiritual needs as part of the radiation oncologist’s management. Among patients with spiritual needs requiring attention, over half had pain management needs. Though these assessments of spiritual issues by clinicians likely greatly underestimates the frequency of patient spiritual needs, the findings do point to the frequent need for clinicians to manage spiritual and pain needs concomitantly in the urgent care setting.