Utilization of Palliative Radiation in Pediatric Oncology Patients at End-of-Life (EOL) (RP214)

Outcomes 1. Increase awareness of the pediatric oncology population receiving pXRT at the EOL and highlight how interdisciplinary team care can improve quality of life during this time.2. Promote standards of care surrounding the use of pXRT to help increase its availability and use during the EOL. Key Message Palliative radiation has the potential to relieve suffering related to refractory symptoms like pain and spinal cord compression for pediatric oncology patients in the end-of-life period. However, this tool remains underutilized in this population for reasons likely related to lack of standardized practice guidelines and subpar identification of eligible patients. Importance Refractory symptom management at the EOL can impact suffering and bereavement for patients and families of children with cancer. Palliative radiation (pXRT) is an underutilized tool that can potentially mitigate suffering and improve quality of life. Objective(s) To describe the patient population receiving pXRT at the EOL at a single tertiary pediatric oncology center. Scientific Methods Utilized Retrospective chart review of pediatric oncology patients over a 10-year period. Descriptive analysis and non-parametric tests to compare groups were used. Results 2202 total deaths occurred; 168 patients met study criteria, reflecting a 7.6% incidence of pXRT at the EOL. Most patients were white (68%) and male (59%), with a median age of 11 years. The most common diagnosis was a solid tumor (52%), followed by CNS tumors (37%), and leukemia (10%). pXRT was primarily used to treat pain (36%) or for palliation (32%) and focused on the brain/spine (35%), head/neck (25%), and pelvis (12%). Median radiation dose delivered was 23.6Gy (range of doses received 1.8-55.8Gy) in a median of 7 fractions (range 1-31). Half of patients required anesthesia for pXRT and a majority did not experience acute side effects (64%). Patients receiving cancer-directed therapy in the last month of life were more likely to receive longer courses of pXRT and were found to have a longer lifespan following pXRT. One in five patients receiving pXRT had a decrease in reported pain scores. Additionally, 88% received a palliative care (PC) consultation which was found to increase the likelihood for hospice referral, documented DNR preferences and decrease episodes of CPR on the day of death. Conclusion(s) There is significant variability in the use of pXRT during pediatric oncology care at the EOL. Impact Guidelines to help standardize palliative XRT may guide clinician decision making for refractory EOL symptom management and increase the utilization of this important tool in addressing suffering. Keywords Palliative care in oncology/Pain and symptom control