Treatment Pathway: Palliative Radiation for Oncology Patients on Hospice

The goals of hospice are to maintain or enhance the comfort, independence, and quality of life for patients who have a life-limiting disease such as cancer and an expectation of six months or less to live. These goals are achieved by reducing burdensome and unnecessary healthcare interventions. The Michigan Oncology Quality Consortium (MOQC), in collaboration with the Michigan Radiation Oncology Quality Consortium (MROQC -a consortium of radiation oncologists across the State of Michigan), andin consultation with hospice medical directors, developed a framework through the MOQC Palliative Radiation Therapy Working Group, to guide the care of hospice patients who could benefit from single-fraction palliative radiation oncology treatment and symptom management. Hospice physicians and radiation oncologists have significant alignment with treatment planning and care in providing symptom management for this population.

With the help of the palliative radiation workgroup, consisting of physicians, radiation oncologists, and hospice providers, MOQC defined the criteria for providing uniform and appropriate single-fraction palliative radiation for selected oncology patients who are enrolled in hospice or who are eligible for hospice. Single-fraction radiation therapy is equivalent in efficacy to longer courses of radiation therapy in these select patients.

MOQC created a mechanism to refer a subset of hospice patients to radiation oncology for treatment while minimizing the financial and care burdens to oncology practices, hospices, and patients/families. Dr. Thomas Boike, a radiation oncologist with GenesisCare pointed out: “Our common goal is improving the lives of patients on hospice. Radiation therapy can be an effective palliative treatment for cancer-related symptoms as pain, bleeding, and airway obstruction. We are now working on disseminating the pathways, while identifying the metrics of their utilization. We have presented these ideas to hospices and would like to welcome all Michigan hospices to participate. Ultimately, we hope to publish our results.” As part of that strategy, MOQC submitted an abstract for a poster presentation during ASCO Quality Symposium in Chicago in October 2022, which was accepted.

Currently, two pathways are active: 1) for oncology patients on hospice with bone metastases, and 2) for oncology patients on hospice with bleeding. Both are available on the MOQC website. You may also reach out to nsimon@moqc.org.

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