A Comprehensive Perspective on Educational and Economic Barriers for Utilization of Palliative Radiation Therapy in Hospice: A Narrative Review

Purpose: Despite the agreed-on efficacy and benefits of palliative radiation therapy (PRT) to alleviate end-of-life complications related to cancer progression, PRT remains an underused treatment in the hospice-care setting.^3-4,6-7 Common barriers for hospice patient use of PRT include educational and economic limitations. This paper discussed these barriers and ways to eliminate them based on previously published interventions. Methods and Materials: Literature search on PubMed; 30 articles were selected by the authors. All articles included are published after the year 2000 in peer reviewed journals. Results: Educational barriers for medical practitioners outside radiation oncology can be addressed by creating formal education programs that reduce knowledge gaps previously identified by survey-based research studies. For radiation oncologists, continued education should focus on increasing competence and comfort with end-of-life conversations and indications for use of single-fraction radiation for patients with advanced cancer. More information on radiation oncology options should be provided to patients. As for economic barriers, rapid-access programs that use advanced level practitioners can increase PRT access by the hospice population. Also, these programs can increase use of single-fraction radiation therapy (SFX RT) in patients with a shorter projected prognosis. SFX RT is beneficial in this setting because it decreases hospice expense and is as efficacious at palliating pain in patients with advanced cancer as multiple-fraction radiation. Conclusions: The barriers of education and economic limitations can be addressed by: expanding the PRT curriculum for all practicing physicians, improving radiation oncologist palliative care knowledge, increasing PRT resources for patients, increasing number of rapid-access radiation therapy programs, and, when indicated, encouraging use of single-fraction radiation treatment for hospice patients.