Session Item

Radiation therapy is an effective treatment in symptomatic patients (metastatic bone pain, hemorrhages or cerebral edema). A notable percentage of patients who arrive at a radiotherapy oncology service and are planned do not receive treatment due to worsening general condition or death. It is important to estimate the life expectancy in order to adapt the appropriate decision making regarding the treatment with radiotherapy in these patients.

OBJECTIVE: To make a scale of assessment of the prognosis that helps us decide on the importance of the indication of palliative radiotherapy and thus reduce the rate of planned patients who do not receive treatment.

After reviewing the literature, we adopted the TEACHH model as a support tool for decision making in palliative radiotherapy. The TEACHH model divides patients into three groups according to life expectancy (1.7; 5 and 19.9 months) based on the score obtained according to the clinical characteristics of the patient (type of cancer, ECOG, age, more of two lines of chemotherapy treatment, previous hospitalizations and the presence of liver metastases). We decided to use the TEACHH model in all hospitalized patients and who present a priori indication of palliative radiotherapy. 

We selected 258 candidate patients for palliative radiotherapy. Radiation therapy was indicated for metastatic bone pain in 38.91% of patients, with haemostatic intention in 10.89%, brain metastases in 22.96%, and finally, for compression of the spinal cord in 17.24% of patients. The remaining 10% were treated for other causes. Of the total patients assessed, 21.77% were in the life expectancy group of 1.7 months; 74.15% in 5 months and 4.08% in 19.9 months. The use of the model allowed us to refuse treatment in 68 (26.46%) patients (30 in the 1.7 month group, 37 in 5 months and 1 in 19.9 months). We planned 31 (12.06%) patients who did not receive death treatment (4 in 1.7 months and 27 in 5 months).

It is a tool that allows us to administer a palliative treatment or reject it in an adjusted way to each patient taking into account their life expectancy, as well as reducing the rate of untreated planned patients by improving the use of the resources of our service.