Memorial Sloan Kettering Cancer Center’s (MSK’s) inpatient radiation oncology consult service (IROC) may improve end of life care and quality of life for patients with metastatic cancer, according to new research published in JAMA Network Open on June 1, 2026. Results showed that after the IROC service was started, fewer patients who died in the hospital received radiation near the end of life and fewer radiation courses were left incomplete. These results suggest that patients who did receive treatment may have been better selected to complete it.
“While radiation therapy can help relieve pain and other symptoms in cancer patients, it may not be helpful and could be harmful for patients who are likely to die within days or weeks,” said first author Alok Deshane, MD, MA. Dr. Deshane is Chief Resident in Radiation Oncology at MSK.
Potential burdens include side effects, time away from family, lower quality of life, and delayed transition to comfort-focused care.
“Radiation may take weeks for intended effect, so patients very close to the end of life may experience the side effects without ever getting the benefit,” Dr. Deshane explained.
Co-founded in January 2020 by Amy J. Xu, MD, PhD, senior author of the study, and Divya Yerramilli, MD, IROC founded in January 2020 by Amy J. Xu, MD, PhD, senior author of the study, and Divya Yerramilli, MD, IROC is a specialized service at MSK that is designed to provide timely access to palliative care for patients with advanced cancers while they are in the hospital. The service draws on the expertise of faculty who are specialists in caring for metastatic cancer and certified in ablative radiation therapy. The IROC reviews cases at multidisciplinary board meetings and provides weekly faculty rotations and consults triaged by dedicated advanced practice providers or resident trainees. Before the IROC was established, consults were handled on an ad hoc basis by resident trainees or rotating faculty.
In past research, MSK’s IROC service has been associated with shorter hospital stays and less unnecessary treatment for patients discharged to hospice. It has also been linked to improvements in goal-oriented care such as increased use of hypofractionated treatment, including single-fraction or short-course fraction for palliation. Decreased use of extended fractionation for palliation of bone metastases is on the top 5 list of the American Society for Radiation Oncology’s Choosing Wisely health initiative to decrease overused, unnecessary and potentially harmful treatment.
Methods
In the study, researchers conducted a retrospective review of medical records for patients seen by the IROC service between January 2019 to December 2023. They identified 450 patients who died within 14 days of inpatient radiation oncology consultation (median[range] age, 63 [12-94] years; 231 females [51.3%]). The 14-day mortality interval was chosen because patients are not likely to benefit from radiation therapy during this time frame. To address possible confounding related to practice changes during the COVID-19 pandemic, the analysis excluded patients seen during 2020.
Researchers then compared clinical characteristics and treatment variables before and after implementation of the IROC service in January 2020.
IROC Tied to More Goal-Concordant End-of-Life Care
Among identified patients, 10.9% (n= 49) were discharged to hospice, 14.9% (n= 67) were discharged from the hospital, and 74.3% (n= 334) died while in the hospital. The most common reasons for radiation were for treating cord compression (24.7%, n=25) and central nervous system disease (22.7%, n=23).Results showed:
- Fewer patients received radiation in the final days of life after IROC implementation compared to before implementation (20.2% vs 31.7%; P = .03).
- Fewer consults resulted in incomplete courses of radiation after IROC implementation (10.0% vs 18.3%; P = .02).
- Fewer patients who died in the hospital received radiation after IROC implementation (14.4% vs 23.9%; P = .02).
These results suggest that radiation was more selectively used for patients likely to complete and benefit from treatment, while helping avoid treatment burdens for patients unlikely to realize benefit.
Limitations
The authors mentioned several potential limitations. Due to the retrospective design, the results cannot prove that the IROC service was the cause of better care near the end of life for these patients. Another potential limitation are unmeasured confounders, such as changes in practice patterns over time, changes in practice related to COVID-19, and patient selection. The authors also note that patients at MSK may pursue more aggressive care compared to community settings.
Improved Comfort Near the End of Life
The results suggest that specialized palliative care models such as the IROC at MSK may improve care and align treatments with expected benefit, symptom needs and patient goals, while limiting burdensome interventions for patients with very limited life expectancy.
“Having a specialized team like the IROC review whether radiation is truly appropriate for seriously ill patients appears to help reduce unnecessary treatment at the end of life. This could improve comfort and quality of care during a patient’s final days,” said senior author Amy J. Xu, MD, PhD, co-founder of the IROC service and Director of the Metastatic Research Program in the Department of Radiation Oncology at MSK. “Our goal with IROC was to bring expert, attending-level radiation oncology input to the bedside so patients receive timely treatment when it can help, and avoid burdensome treatment when it is unlikely to improve symptoms or quality of life.”
Disclosures
Dr. Deshane reports no disclosures. Dr. Xu reports personal fees from AstraZeneca for advisory board membership.