Health economic and health service issues of palliative radiotherapy

Palliative radiotherapy (PRT) makes up about half of all courses delivered in radiotherapy departments. It is effective in the management of common complications of cancer and is relatively inexpensive. About one third of cancer patients receive PRT within the last 2 years of life. One quarter of all patients who receive radiotherapy will undergo a second or subsequent course, mostly for palliative indications. There is considerable variation in practice, both within and between jurisdictions. This has been attributed to inconsistencies in guidelines, physician variation and differing financial incentives. Because of the widespread use of hypofractionation, variation in PRT fractionation has a lower effect on departmental capacity than variation in radical and adjuvant treatments. Excessive fractionation places an unnecessary burden on frail patients at the end of their lives and uses scarce healthcare resources. With appropriate case selection, the increased cost of fractionation or more conformal treatments can be justified where clinical benefit is expected.