Journal of Palliative Care & Medicine
Open Access

Palliative radiotherapy; Cancer-related symptoms; Symptom management; Supportive care; Palliative care; Radiation oncologists; Specialized training; Palliative care specialists; Quality of life

Introduction

Palliative radiotherapy (PRT) plays a pivotal role in the management of cancer-related symptoms, offering relief and improved quality of life to patients with advanced cancer. However, despite its recognized efficacy, the widespread implementation of PRT is impeded by various barriers that may hinder patient support during treatment. Proposed strategies include specialized training for supportive and palliative care specialists in PRT and palliative care training for radiation oncologists [1].

Specialized training for supportive and palliative care specialists: One key barrier to the effective use of PRT in palliative care is the lack of specialized training for supportive and palliative care specialists in radiotherapy techniques. Palliative care specialists are often well-versed in managing symptoms through medications and psychosocial support, but they may not have the necessary expertise in PRT [2 ]. To address this gap, specialized training programs can be developed to educate palliative care teams about the principles and practices of PRT.

These programs should focus on educating palliative care specialists about the indications for PRT, the potential benefits, and the management of common radiation-related side effects [3]. By enhancing the knowledge and skills of these professionals, patients can receive a more comprehensive and coordinated approach to symptom management, integrating both pharmaceutical and radiation-based interventions.

Palliative care training for radiation oncologists

Conversely, radiation oncologists who are primarily trained to deliver curative treatments may benefit from additional education in palliative care principles. While they are experts in radiotherapy techniques, radiation oncologists may not always have the expertise to address complex symptom management and psychosocial support effectively [4-6]. To bridge this gap, incorporating palliative care training into the curriculum of radiation oncologists during their residency and continuous medical education is crucial. Radiation oncologists should be equipped not only to plan and deliver PRT but also to assess and manage symptoms, rapidly refer patients to specialists for complex symptoms, and collaborate effectively in multidisciplinary palliative care teams. This comprehensive education can ensure that PRT is seamlessly integrated into the overall care plan for patients with advanced cancer.

Dedicated pathways and organizational models

The introduction of dedicated pathways and organizational models for palliative radiotherapy (PRT) is a crucial step towards enhancing its effectiveness and ensuring that it becomes an integral part of palliative care for patients with advanced cancer [7 ]. These pathways and models serve as structured frameworks that guide healthcare providers in the strategic and coordinated use of PRT in the palliative setting.

Clear guidelines for appropriate use: Dedicated pathways for PRT offer clear and standardized guidelines for healthcare providers, including radiation oncologists and palliative care specialists, regarding the appropriate utilization of this treatment modality. These guidelines help in identifying which patients would benefit the most from PRT, considering factors such as the type and stage of cancer, the presence of specific symptoms, and the patient's overall condition. Having welldefined criteria for PRT eligibility ensures that it is administered when it is most likely to provide significant symptom relief and improve the patient's quality of life. This, in turn, prevents unnecessary radiation therapy in cases where its benefits may be limited [8].

Informed decision-making: These pathways enable informed decision-making by healthcare teams. They provide valuable insights into the potential benefits and risks associated with PRT, allowing healthcare providers to discuss treatment options with patients and their families more comprehensively [9]. Informed decision-making ensures that patients are actively involved in their care and can make choices that align with their preferences and goals.

Integration with supportive therapies: Organizational models that integrate PRT with other supportive therapies, such as hospice and palliative care services, are instrumental in optimizing patient care.

This integration fosters a holistic approach to patient management, recognizing that cancer care extends beyond radiation treatment alone. By combining PRT with other forms of supportive care, patients receive a comprehensive and well-rounded treatment plan that addresses not only their physical symptoms but also their psychosocial and emotional needs [10]. This synergy between treatment modalities can lead to more effective symptom management and an overall improved quality of life for patients with advanced cancer.

Enhanced communication and coordination: Perhaps one of the most significant advantages of these organizational models is the improvement in communication and coordination among healthcare providers. PRT is often just one piece of the puzzle in the complex care of patients with advanced cancer. When it is seamlessly integrated with other palliative care services, healthcare teams collaborate more effectively [11-15 ]. This improved coordination ensures that patients receive timely and appropriate interventions. For example, if a patient's symptoms worsen or change, the communication channels are open for swift adjustments to the treatment plan, including PRT if necessary. This proactive approach prevents delays in care and minimizes the burden on patients and their families.

Conclusion

In conclusion, palliative radiotherapy is a valuable tool for alleviating cancer-related symptoms and improving the quality of life for patients with advanced cancer. However, the implementation of PRT in palliative care faces various barriers that can hinder its widespread use and impact patient support during treatment. To address these barriers and enhance the quality of PRT, specialized training for supportive and palliative care specialists in PRT and palliative care training for radiation oncologists should be prioritized. Additionally, the introduction of dedicated pathways and organizational models for PRT can improve its integration into palliative care. While evidence on innovative organizational models and training experiences remains limited, existing studies highlight the advantages of integrating PRT with supportive therapies. To collaborate in multidisciplinary palliative care teams. These frameworks provide clear guidelines for its use, promote informed decision-making, and facilitate integration with other supportive therapies. By doing so, they foster improved communication and coordination among healthcare providers, ultimately benefiting the well-being of patients and their families facing the challenges of advanced cancer. By implementing these strategies, healthcare providers can work together to overcome barriers and ensure that PRT is readily available and effectively utilized in the care of patients with advanced cancer, ultimately improving their quality of life during challenging times.

Acknowledgement:

None.

Conflict of interest:

Author declares no conflict of interest.

1. Harris D (2019) Safe and effective prescribing for symptom management in palliative care. Br J Hosp Med 80: 184-189.

Indexed at, Google Scholar, Crossref

2. Tjia J, Kutner JS, Ritchie CS, Blatchford PJ, Bennett Kendrick RE, et al. (2017) Perceptions of Statin Discontinuation among Patients with Life-Limiting Illness. J Palliat Med 20:1098-1103.

Indexed at, Google Scholar, Crossref

3. Turner JP, Shakib S, Singhal N, Hogan-Doran J, Prowse R, et al. (2014) Statin use and pain in older people with cancer: A cross-sectional study. J Am Geriatr Soc 62:1900-1905.

Indexed at, Google Scholar, Crossref

4. Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, et al. (2017) Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records. Circulation 135:2357-2368.

Indexed at, Google Scholar, Crossref

5. Satish S, Freeman DH, Ray L, Goodwin JS (2001) The relationship between blood pressure and mortality in the oldest old. J Am Geriatr Soc 49:367-374.

Indexed at, Google Scholar, Crossref

6. Pisani L, Hill NS, Pacilli AMG, Polastri M, Nava S (2018) Management of Dyspnea in the Terminally Ill. Chest 154:925-934.

Indexed at, Google Scholar, Crossref

7. Warraich HJ, Rogers JG, Dunlay SM, Hummel E, Mentz RJ (2018) Top Ten Tips for Palliative Care Clinicians Caring for Heart Failure Patients. J Palliat Med 21:1646-1650.

Indexed at, Google Scholar, Crossref

8. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, et al. (2015) Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Intern Med 175:827-834.

Indexed at, Google Scholar, Crossref

9. Meyer-Junco L (2021) Time to Deprescribe: A Time-Centric Model for Deprescribing at End of Life. J Palliat Med 24:273-284.

Indexed at, Google Scholar, Crossref

10. Dewhurst F, Baker L, Andrew I, Todd A (2016) Blood pressure evaluation and review of antihypertensive medication in patients with life limiting illness. Int J Clin Pharm 38:1044-1047.

Indexed at, Google Scholar, Crossref

11. Morin L, Wastesson JW, Laroche ML, Fastbom J, Johnell K (2019) How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study. Palliat Med 33:1080-1090.

Indexed at, Google Scholar, Crossref

12. Todd A, Al-Khafaji J, Akhter N, Kasim A, Quibell R, et al. (2018) Missed opportunities: Unnecessary medicine use in patients with lung cancer at the end of life–An international cohort study. Br J Clin Pharmacol 84:2802-2810.

Indexed at, Google Scholar, Crossref

13. Schenker Y, Park SY, Jeong K, Pruskowski J, Kavalieratos D, et al. (2019) Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness. J Gen Intern Med 34:559-566.

Indexed at, Google Scholar, Crossref

14. Stephan D, Grima M, Welsch M, Barthelmebs M, Vasmant D, et al. (1996) Interruption of prolonged ramipril treatment in hypertensive patients: Effects on the renin-angiotensin system. Fundam Clin Pharmacol 10:474-483.

Indexed at, Google Scholar, Crossref

15. Bhagat AA, Greene SJ, Vaduganathan M, Fonarow GC, Butler J (2019) Initiation, Continuation, Switching, and Withdrawal of Heart Failure Medical Therapies During Hospitalization. JACC Heart Fail 7:1-12.

Indexed at, Google Scholar, Crossref