Impact of palliative radiotherapy in patients with gynecologic malignancies on end-of-life outcomes

Objectives — We investigated the use of radiotherapy toward the end of life (EOL) in patients with gynecologic malignancies and its relationship to established EOL healthcare quality indicators.

Methods — A population-based, retrospective cohort study of gynecologic cancer decedents in Ontario, Canada from 2006 to 2018 using ICES-linked administrative health care data.

Results — Of 16,237 decedents, 26.7% received palliative radiotherapy; 6.7% in the last 31–90d of life (“late radiation”), and 5.3% in the final 30d (“EOL radiation”). The most common site was pelvis (44.2%), with single fractions used in 13.4% of late and 14.1% of EOL regimens. On multivariable analysis, age < 40 years, non-ovarian cancers, and stage IV disease at diagnosis were associated with receipt of late and EOL radiation.

Late radiation was associated with the lowest rates of aggressive EOL care in the final 30d (15.6% vs. 27.7% with EOL radiation vs. 21.0% with neither), including hospitalization and death in hospital. On multivariable regression, late radiation remained significantly associated with less aggressive (OR 0.80, 95% CI 0.67–0.96) and more supportive EOL care (OR 1.24, 95% CI 1.07–1.44), and lower risk of death in hospital (OR 0.86, 95% CI 0.75–0.98), while EOL radiation was associated with more aggressive EOL care (OR 1.41, 95% CI 1.16–1.73) and death in hospital (OR 1.71, 95% CI 1.44–2.02).

Conclusion — Most patients received multifractionated schedules with both late and EOL radiation. While EOL radiation was associated with more aggressive EOL care, late palliative radiation was associated with less aggressive EOL healthcare utilization and more supportive care.