Treatment Pathway: Palliative Radiation for Oncology Patients with Bleeding on Hospice

The goals of hospice are to maintain or enhance the comfort, independence, and quality of life for patients who have a life limiting disease such as cancer and an expectation of six months or less to live. These goals are achieved by reducing burdensome, unnecessary healthcare interventions for the patient and their caregivers and family. Michigan Oncology Quality Consortium (MOQC), in collaboration with hospice medical directors and radiation oncologists across the State of Michigan, developed a framework to guide the care of hospice patients who could benefit from palliative radiation oncology treatment.

With the help of the palliative radiation workgroup, consisting of physicians, radiology oncologists, and hospice providers, MOQC defined the criteria for providing uniform and appropriate palliative radiation for selected oncology patients who are enrolled in hospice. MOQC described a mechanism to refer and treat a subset of hospice patients to radiation oncology for treatment, while minimizing the financial and care burden to oncology practices, hospices, and patients/families. Radiation therapy can be an effective palliative treatment for cancer‐related symptoms such as pain, bleeding, and airway obstruction. Hospice physicians and radiation oncologists have significant alignment with treatment planning and care in providing symptom management for this population. The treating physician must provide care based on relevant and presenting information to determine the propriety of any specific treatment pathway or course of action.

Radiation oncologists in 19 practices across the state agreed to high value radiation treatment (focused level 3 consultation, complex isodose planning, and single fraction treatment). Eligible patients may be seen via virtual consultation and then treated within 1 to 2 days with a single fraction of 8 Gy. A second fraction can be given in patients who continue to have bleeding. MOQC established direct connection to members of the collaborative whose contact information is available on the MOQC website.