NCCN Guidelines for Palliative Care V.1.

2017 –Meeting on 09/28/2016

Guideline Page Panel Discussion/References Institution Vote

and Request
YES NO ABSTAIN ABSENT

PAL-1 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: to address this topic on subsequent guidelines pages.
Submission from
ASTRO to revise References:
pathway to add the  Lutz ST, Jones J, Chow E. Role of Radiation Therapy in Palliative Care of the Patient
role of radiation with Cancer. JOC. 2014;55:1143
oncology in the care  Mackillop WJ, Kong W. Estimating the need for palliative radiation therapy: a
of the palliative benchmarking approach. Int J Radiation Oncol Biol Phys. 2016; 94(1):51-59
patient.
PAL-3 Based on the data in the noted reference(s) and discussion, the panel consensus was 17 0 0 9
External request: to add the suggested indications for palliative RT on PAL-9.
Submission from
ASTRO to separate See submission for references.
the indications on
PAL-3 between
medical
management vs.
radiation therapy
management and to
add clinical
situations and/or
problems that RT
can resolve with
minimally invasive
short courses, such
as: spine metastases
or any other bone or
brain metastases.

1
NCCN Guidelines for Palliative Care V.1.2017 –Meeting on 09/28/2016

Guideline Page Panel Discussion/References Institution Vote

and Request
YES NO ABSTAIN ABSENT

PAL-5 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not to include the recommendations on Pal-5 as the suggested recommendations are
Submission from addressed in the Palliative Care Guideline pages PAL-25 and PAL-26.
ASTRO to revise the
pathway to address References:
housing,  Lutz S, Spence C, Chow E, et al. Survey on use of palliative radiotherapy in hospice
transportation, care. J Clin Oncol. 2004;22:3581–3586. [PubMed]
communication,  McCloskey SA, Tao ML, Rose CM, et al. National survey of perspectives of palliative
family members’ radiation therapy: Role, barriers, and needs. Cancer J. 2007;13:130–137.
distress as well as  National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines
patients, and the for Quality Palliative Care, 2nd edition. 2009
need for interpreters.
PAL-6 and PAL-7 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not to include the recommendation.
Submission from
ASTRO to revise the References:
pathway to add the  Nieder C, Dalhaug A, Pawinski A, et al. Palliative radiotherapy with or without
role of RT to these additional care by a multidisciplinary palliative care team in patients with newly
areas. diagnosed cancer: a retrospective matched pairs comparison. Radiation Oncology.
2015;10:61
 Tseng YD, Krishnan MS, Jones JA, et al. Supportive and palliative radiation oncology
service: Impact of a dedicated service on palliative cancer care. Practical Radiation
Oncology. 2014;4:247-253
PAL-6 Based on the data in the noted reference(s) and discussion, the panel consensus was 17 0 0 9
External request: to include the recommendation on PAL-7.
Submission from
ASTRO to add References:
“Any patient with a  World Health Organization - Cancer: WHO Definition of Palliative Care. Retrieved
potentially life- May 16, 2016 from http://www.who.int/cancer/palliative/definition/en/.
 Lutz ST, Jones J, Chow E. Role of Radiation Therapy in Palliative Care of the Patient
limiting cancer
with Cancer. JOC. 2014; 55:1143
diagnosis.”

2
NCCN Guidelines for Palliative Care V.1.2017 –Meeting on 09/28/2016

PAL-6 Based on the data in the noted reference(s) and discussion, the panel consensus was 17 0 0 9
External request: to address RT for painful bone metastases on PAL-9 and PAL-10.
Submission from
ASTRO that patients References:
should take part in  Lutz S, Berk L,Chang E, et al. Palliative radiotherapy for bone metastases: An
decision making ASTRO evidence based guideline. Int J Radiat Oncol Biol Phys 2011;79:965-76.
regarding the
tradeoffs associated
with single versus
fractionated
radiotherapy for
painful bone
metastases.
PAL-7 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not include the recommendation as this issue is addressed elsewhere in the guidelines.
Submission from
ASTRO to revise References:
statement to include  Tang S, Liu T, Tsai C, et al. Patient awareness of prognosis, patient-family caregiver
the phrase “Family congruence on the preferred place of death, and caregiving burden of families
discord, either in contribute to the quality of life for terminally ill cancer patients in
general or Taiwan.Psychooncology. 2008; 17:1202-1209.
specifically  Tang S, Liu T, Lai M, et al. J Pain Symptom Manage. Concordance of preferences
related to goals of for end-of-life care between terminally ill cancer patients and their family caregivers in
care.” Taiwan. 2005;30:510-518.
PAL-8 Based on the data in the noted reference(s) and discussion, the panel consensus was 17 0 0 9
External request: to address the role of palliative RT for pain relief on PAL-10.
Submission from SAVE FOR NEW PAGE IN GL
ASTRO under the
heading “intensify References:
palliative care  Chow E, van der Linden Y, Roos D, et al. A randomized trial of single versus multiple
interventions” fractions (Fx) for re-irradiation (RE-RT) of painful bone metastases (PBM): NCIC
include the CTG SC.20. J Clin Oncol 31, 2013 (suppl; abstr 9502).
information that  Kim EY, Chapman TR, Ryu S, Chang EL, Galanopoulos N, Jones J, Kubicky CD,
Radio-therapy Lee CP, Teh BS,Traughber BJ, Van Poznak C, Vassil AD, Weber K, Lo SS. ACR
retreatment to the Appropriateness Criteria(®) non-spine bone metastases. J Palliat Med. 2015
same site of painful Jan;18(1):11-7. doi: 10.1089/jpm.2014.9395.
bone metastases
can effective provide
pain relief.

3
NCCN Guidelines for Palliative Care V.1.2017 –Meeting on 09/28/2016

Guideline Page Panel Discussion/References Institution Vote

and Request
YES NO ABSTAIN ABSENT

PAL-15 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not to include the recommendation.
Submission from
ASTRO to revise See submission for references.
pathway to add RT
as a tool in the
management of
gastric outlet
obstruction from
tumor.
PAL-17 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not to include the recommendation.
Submission from
ASTRO to revise References:
pathway to add RT  Cameron MG, Kersten C, Vistad I, Fosså S, Guren MG. Palliative pelvic radiotherapy
as a tool to manage of symptomatic incurable rectal cancer - a systematic review. Acta Oncol. 2014
constipation from Feb;53(2):164-73
tumor.
PAL-18 Based on the data in the noted reference(s) and discussion, the panel consensus was 17 0 0 9
External request: to include assessment of RT side effects and RT-induced enteritis on PAL-18.
Submission from
ASTRO to add RT to References:
the list as a potential  Cherny NI. Evaluation and management of treatment-related diarrhea in patients
cause of diarrhea with advanced cancer: a review. J Pain Symptom Manage. 2008 Oct;36(4):413-23.
and recommend
consideration of a
treatment
interruption/
cessation in order to
manage the
symptom.

4
NCCN Guidelines for Palliative Care V.1.2017 –Meeting on 09/28/2016

Guideline Page Panel Discussion/References Institution Vote

and Request
YES NO ABSTAIN ABSENT

PAL-21 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not to include the recommendation.
Submission from
ASTRO to revise References:
pathway to add RT  Cameron MG, Kersten C, Vistad I, Fosså S, Guren MG. Palliative pelvic radiotherapy
as a tool to manage of symptomatic incurable rectal cancer - a systematic review. Acta Oncol. 2014
bowel obstruction Feb;53(2):164-73
from tumor.  De Meerleer G, Vandecasteele K, Ost P, Delrue L, Denys H, Makar A, Speleers B,
Van Belle S, Van den Broecke R, Fonteyne V, De Neve W. Whole abdominopelvic
radiotherapy using intensity-modulated arc therapy in the palliative treatment of
chemotherapy-resistant ovarian cancer with bulky peritoneal disease: a single-
institution experience. Int J Radiat Oncol Biol Phys. 2011 Mar 1; 79(3):775-8.
PAL-23 Based on the data in the noted reference(s) and discussion, the panel consensus was 0 17 0 9
External request: not to include the recommendation.
Submission from
ASTRO to revise References:
pathway to add RT  Gofton TE, Graber J, Carver A. Identifying the palliative care needs of patients living
as a tool to manage with cerebral tumors and metastases: a retrospective analysis. J Neurooncol. 2012
delirium if it is Jul; 108(3):527-34.
associated with CNS  Yamanaka R, Koga H, Yamamoto Y, Yamada S, Sano T, Fukushige T.
disease. Characteristics of patients with brain metastases from lung cancer in a palliative
care center. Support Care Cancer. 2011 Apr;19(4):467-73.