hospice care, palliative radiation, single fraction



  1. Schuster, Jessica MD
  2. Han, Tatiana BS
  3. Anscher, Mitchell MD
  4. Moghanaki, Drew MD, MPH


Radiotherapy effectively palliates malignant sources of pain. However, once enrolled on hospice, patients are rarely referred for this treatment. To develop educational strategies that can improve access to care, a survey of hospice providers investigated potential misconceptions about its benefits and availability. Individual surveys were distributed to administrators, nursing directors, and medical directors at 16 licensed hospices within 25 miles of a radiation oncology facility. Ninety-three percent of hospice professionals stated radiotherapy provides pain relief and is appropriate for patients with more than 1 month of life expectancy. However, less than 1% of their cancer patients had been referred to a radiation oncologist over the past year, citing concerns about cost and travel burden. Whereas most medical directors (75%) were aware it is just as effective when delivered in a single fraction, very few administrators (22%) and nursing directors (21%) had this knowledge. Meanwhile, reluctance of a radiation oncologist to offer single-fraction palliative radiotherapy was experienced by 43%. Access to palliative radiotherapy for this unique population can be increased by improving education for hospice administrators and nursing directors and reminding radiation oncologists that single-fraction palliative radiotherapy is acceptable and ideal for patients with limited financial resources at the end of life.