Kavita Dharmarajan, MD, M.Sc
Advanced-stage cancer patients who received palliative care required shorter durations of radiation treatment and had shorter hospital stays, according to a recent study at the Icahn School of Medicine at Mount Sinai.
“Radiation therapy is very effective at relieving pain, but the standard two weeks of treatment may be too long or burdensome for some patients, given the state of their illnesses,” says the study’s senior author, Kavita Dharmarajan, MD, M.Sc, Assistant Professor of Radiation Oncology, and Geriatrics and Palliative Medicine, at the Icahn School of Medicine at Mount Sinai. “We showed that shorter course treatments can be equally, if not more, effective, especially when combined with other forms of therapy that put patients first, and not the tumor.”
Dr. Dharmarajan presented the study in October at the Palliative Care in Oncology Symposium in Boston. The researchers evaluated 336 patients with stage IV cancer who were receiving radiation for symptomatic bone metastases. Of the 161 patients who received a combination of palliative care and short-course treatments (five or fewer sessions over the course of a week), the length of hospital stay declined by six days (from 18 to 12), the number of unfinished treatments dropped from 15 percent to 8 percent, and more patients accessed palliative care services within 30 days of finishing radiation (49 percent vs. 34 percent).
In addition, the study reported a slight improvement in the number of patients experiencing pain relief despite the reduction in radiotherapy.
As Dr. Dharmarajan points out, upwards of 40 percent of all patients undergoing radiation as part of cancer treatment do so for palliative reasons, to alleviate or prevent symptoms rather than to cure their disease. “The standard ten fractions (two weeks) of radiation treatment may be overkill for what many of these patients need,” Dr. Dharmarajan says. “I feel strongly that as radiation oncologists, we can better serve these late-stage patients by treating them holistically, with radiation as well as non-radiation therapies, to manage their pain, nausea, fatigue, depression, and anxiety.”
Since many patients are unfamiliar with palliative care, Dr. Dharmarajan says physicians have an obligation to refer patients to palliative care specialists and “to explain how it can help them and their families deal with their illnesses.”
Dr. Dharmarajan says she hopes her study will create awareness that small changes in everyday treatment can significantly impact outcomes. “We’re showing patients that their voices really matter when making decisions about palliative care and radiation treatment,” she says. “They may decide against a lengthy course of radiation, or decide to reprioritize their goals.”
In 2014, the American Cancer Society awarded its prestigious Clinical Research Professor grant to R. Sean Morrison, MD, Director of the Lilian and Benjamin Hertzberg Palliative Care Institute at the Mount Sinai Health System. Dr. Morrison, a pioneer in the field—and the Hermann Merkin Professor of Palliative Care at the Icahn School of Medicine at Mount Sinai—helped launch Mount Sinai’s palliative care program in the mid-1990s. Over the past decade, more than half of U.S. hospitals have begun using hospital-based palliative care models developed at Mount Sinai.