Radiotherapy for pain associated with cancer in palliative care

Palliative radiotherapy can relieve pain associated with localised disease (eg bone metastases) within 2 to 3 weeks, potentially reducing analgesic requirements after this time. Because of this delay, radiotherapy for pain management is not recommended for patients with an expected short life expectancy (eg days to weeks) and poor performance statusCrawford, 2021. Also consider patient factors; for example, ability to travel in the last weeks of life to locations providing radiotherapy.

Radiotherapy for pain associated with localised cancer deposits (eg bone metastases) may be repeated depending on the nature of the pain, response to initial treatment, and the initial dose and fractionation scheduleLutz, 2017—seek advice from a radiation oncologist.

Patients undergoing radiotherapy for pain management can sometimes experience an initial flare of pain, or occasionally a rapid and dramatic reduction in pain (with associated risk of increased opioid adverse effects, including opioid-induced ventilatory impairment). Review analgesic therapy, monitor the patient and ensure there is a plan in the event of a rapid change in pain intensity—consider seeking expert advice.