While radiation therapy plays an important role in the curative treatment of non-metastatic prostate cancer, it is also used as an effective palliative therapy option for patients with advanced stage disease that is causing pain and other discomfort—particularly for men whose cancer has spread to their bones.1,2,3 Ensuring men with end stage prostate cancer have access to palliative radiation therapy when needed is an important aspect of quality care.
Given the large impact of debilitating pain on a person’s quality of life, it is important to monitor access to treatments that can help manage distressing physical and emotional symptoms. It is also important to understand why these treatments may be used differently across jurisdictions.
Because reliable information on treatment intent is not routinely collected in provincial data sources, we are examining the use of palliative radiation therapy indirectly. This has been achieved by measuring the percentage of prostate cancer patients receiving radiation therapy within one year prior to death from prostate cancer. Using this time frame increases the likelihood that the radiation therapy was delivered for palliative intent. Data (where available) were provided by the provincial cancer agencies and include men who died from prostate cancer in 2011.
What are the results?
Among men who died from prostate cancer in 2011, fewer than 40% received radiation therapy during the last year of their lives (Figure 5.10).
There was some variation across reporting provinces in the use of radiation therapy within the last year of life among men who died from prostate cancer. Rates of use ranged from 17.1% in Manitoba to 38.4% in Alberta.
What do the results mean?
The underuse of palliative radiation therapy (PRT) is well-documented in the research literature, despite the evidence of its effectiveness for managing pain.4,5 The results shown here may support those findings.
Physician referral practices have been identified as one of the most influential drivers of PRT uptake. For men with metastatic prostate cancer, the referring physician can be a radiation oncologist, medical oncologist, palliative care specialist or primary care physician. Several factors may influence a physician’s decision to refer a patient for such therapy. These include the patient’s age, the type and stage of his prostate cancer, the presence of other comorbid conditions, the patient’s personal preference and the patient’s proximity to a radiation centre.2,4,5 It can also include the physician’s awareness and understanding of PRT as an effective way to manage pain.6
Other research has found that older men with prostate cancer were less likely to receive palliative radiation therapy than younger men.7 In provinces with an older population, men may be less likely to be referred for PRT; however, according to demographic information from 2011, Alberta and Manitoba were the provinces with the fewest men aged 65 years and older, yet as shown here, these provinces had the highest and lowest PRT rates, respectively.8
Provinces with regional rapid PRT programs in place may also have higher rates of use. These clinics provide more streamlined access to radiation therapy: patients can be seen quickly for consultation and treatment. For example, Alberta has such a program in place at the Cross Cancer Institute in Edmonton;9 this could explain the relatively higher PRT use in Alberta which are reported here.
A study from Nova Scotia found that fewer than 30% of men who died from prostate cancer between 2000 and 2005 had received palliative radiotherapy5—which is similar to the rate of 28% for Nova Scotia presented in this report.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Version 2.2014. Chicago (IL): American Joint Committee on Cancer; 2014. 98 p.
Huang J, Zhou S, Groome P, Tyldesley S, Zhang-Solomans J, Mackillop WJ. Factors affecting the use of palliative radiotherapy in Ontario. J Clin Oncol. 2001 Jan 1;19(1):137-44.
Boyer MJ, Salama JK, Lee WR. Palliative radiotherapy for prostate cancer. Oncology (Williston Park). 2014 Apr;28(4):306-12.
Samant RS, Fitzgibbon E, Meng J, Graham ID. Barriers to palliative radiotherapy referral: a Canadian perspective. Acta Oncol. 2007;46(5):659-63.
Lavergne MR, Johnston GM, Gao J, Dummer TJ, Rheaume DE. Variation in the use of palliative radiotherapy at end of life: examining demographic, clinical, health service, and geographic factors in a population-based study. Palliat Med. 2011 Mar;25(2):101-10.
Gillan C, Briggs K, Pazos AG, Maurus M, Harnett N, Catton P, et al. Barriers to accessing radiation therapy in Canada: a systematic review. Radiat Oncol. 2012;7:167.
Wong J, Xu B, Yeung HN, Roeland EJ, Martinez ME, Le QT, et al. Age disparity in palliative radiation therapy among patients with advanced cancer. Int J Radiat Oncol Biol Phys. 2014 Sep 1;90(1):224-30.
Statistics Canada. The Canadian Population in 2011: Age and Sex. Ottawa (ON): Ministry of Industry; 2012 May. 27 p. Report No.: 98-311-X2011001.
Fairchild A, Pituskin E, Rose B, Ghosh S, Dutka J, Driga A, et al. The rapid access palliative radiotherapy program: blueprint for initiation of a one-stop multidisciplinary bone metastases clinic. Support Care Cancer. 2009 Feb;17(2):163-70.
This indicator only provides insight about the proportion of men who received palliative radiation therapy (PRT) during the study period. It does not quantify the period of time during which they received treatment, the number of fractions received or the length of time since their last PRT treatment.
From the data submitted, we do not know the reason for radiation therapy treatment. We cannot confirm that such treatment was undertaken for palliative purposes; however, it is likely that most of the men with prostate cancer who received radiation therapy within the last year of life did so for palliation (i.e., pain relief).
Definition: Percentage of prostate cancer cases (men aged 35 and older) receiving radiation therapy within one year prior to death
Numerator: Of the denominator, total number of cases receiving radiation therapy within one year prior to death
Denominator: Total number of deaths with the cause of prostate cancer in 2011
Data source: Provincial cancer agencies
Measurement timeframe: 2011 year of death
Stratification variables: N/A
Provinces submitting data: AB, BC, PE, NS, SK, MB
Province-specific notes: AB: Radiation therapy data was from EMR database, hence not including out-of-province treatment.
Cause of death identified from Vital Statistics death database.
Only provincial residents included.
Denominator includes prostate cancer deaths of all ages