Variation in delivery of palliative radiotherapy to persons dying of cancer in Nova Scotia, 1994 to 1998

Purpose: To examine sociodemographic and clinical variables associated with provision of palliative radiotherapy (RT) to persons dying of cancer. Methods: The Novel Scotia Cancer Registry was used to identify 9,978 adults who were dying of cancer between 1994 and 1998 in the Canadian province of Nova Scotia. RT records from between April 1992 and December 1998 were obt ained from the provincial treatment database. Multivariate analysis identif ied factors associated with two sequential decisions determining provision of palliative RT in the last 9 months of life: likelihood of receiving an R T consultation with a radiation oncologist and, given a consultation, likel ihood of being treated with palliative RT. Results: The likelihood of having a consultation decreased with age (20 to 59 years v 80+ years: odds ratio [OR], 4.43 [95% confidence interval, 3.80 to 5.15]), increased with community median household income (> $50,000 v < $20,000: OR, 1.31 [1.02 to 1.70]), was higher for residents closer to the c ancer center (< 25 km v 200+ km: OR, 2.47 [2.16 to 2.83]), increased betwee n 1994 and 1998 (OR, 1.34 [1.16 to 1.56]), varied by cause of death (relati ve to thoracic cancers, head and neck: OR, 1.75 [1.31 to 2.33]; gynecologic : OR, 0.35 [0.27 to 0.44]), and was greater for those who held prior RT (OR , 2.20 [1.89 to 2.56]). Similar associations were observed when outcome was the provision of palliative RT given a consult, with one notable exception : prior RT was associated with a lower likelihood of receiving palliative R T (OR, 0.48 [0.40 to 0.58]). Conclusion: Variations observed in delivery of palliative RT should prompt further investigation into equity of access to clinically appropriate, pall iative radiation consultation and treatment. (C) 2001 by American Society o f Clinical Oncology.