On October 18, the Society for Palliative Radiation Oncology (SPRO) held its annual meeting in San Antonio, TX, in conjunction with the American Society for Radiation Oncology (ASTRO) annual meeting. Dr. Stephen Lutz welcomed everyone to the meeting and reviewed the initiatives that have been undertaken since SPRO was formally introduced one year before. He then introduced speakers in three categories: Research, Education, and Advocacy.
For clinical research, Dr. Chad Tang from MD Anderson presented the Prognostic Index for Spine Metastases (PRISM), a measure that aims to categorize patients with excellent or poor prognosis following stereotactic spine radiosurgery and to help identify the rationale for single or multiple fraction regimens. The PRISM score categorizes gender, Karnofsky Performance Score, prior surgery, previous radiotherapy to the affected site, number of organ system involved with metastasis, solitary versus multiple spine metastases, and time from diagnosis to discovery of metastasis. The PRISM model allows for stratification of metastatic patients with poor and excellent survival after SSRS. Group 4, with the worst prognosis, had median survival of 9.1 months after SSRS treatment. Groups 3 and 2 achieved median survival of 22.2 months and 32.4 months, respectively. Group 1, with the most favorable prognosis, showed the best survival with 65% of the patients living more than 60 months after treatment. Dr. Tang invited suggestions and collaborative data accrual from experts at other radiotherapy centers.
In the education section of the meeting, Dr. Randy Wei from UC Irvine presented preliminary survey results of radiation oncology residency directors regarding their thoughts about palliative care training within radiation oncology residency programs. Approximately, 70% of US Residencies have formal palliative care curriculum. Still, 36% 36% of programs offer no instruction recognizing when to stop or not start radiation therapy in end of life patients. The survey is to be completed by the end of 2015 with plans for publication in early 2016.
Dr. Drew Moghanaki from Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center presented palliative radiotherapy advocacy efforts within the veterans’ system. He described a predicament that veterans face when they enroll in hospice, namely that they lose their VA benefits and become ineligible for palliative radiation treatment. Dr. Mognahaki and his colleagues have begun an effort to allow for the provision of radiotherapy for veterans who have been admitted to hospice, with the additional goal of creating a model for similar patterns of care in civilian hospitals.
Following the presentations, small working groups brainstormed ideas for further improvements in palliative oncology care. One of the initiatives that garnered the most interest was the need for a greater push towards including palliative care questions on national board exams for radiation oncology. Furthermore, the group declared its support for both the formation of palliative radiotherapy clinical services in tertiary care centers as well as improved collaboration with palliative care services in hospitals throughout the United States.