Patterns of palliative radiotherapy in Canada.

A questionnaire study was performed to determine patterns of radiotherapy practice across Canada and the relationship of age, work-load, resources, intent and aims of therapy on departmental policy; 99 returns were analysed. Three case scenarios were given: Brain metastases were treated typically without a simulation as a parallel pair with palliative intent to 2000 cGy in 5 fractions; for locally advanced lung cancer most patients were simulated, but 40% we deemed 'radical' and there was a bimodal pattern of dose fractionation (the age of the radiation oncologist appeared to influence this and geographical differences were also notable); bony metastases from breast cancer were typically simulated as a single field using 2000-2500 cGy in 5 fractions and always considered palliative. Work-load and resources are likely to influence patterns of care. For example, over 20% felt that treatment choice was suboptimal, largely due to lack of radiation technologists and megavoltage equipment. The implications of these determinants on palliative care are discussed. Objective criteria and definitions are required to allow satisfactory workload measurements and comparisons to be made.