Project Description
Defining the Role of Palliative Care in Radiation Oncology
Each year approximately 3.7 million individuals suffering
from advanced cancer undergo radiation treatment (RT) with palliative
(non-curative) intent. Palliative RT can effectively alleviate cancer-related
symptoms and improve quality of life but may also cause significant adverse
effects. Radiation oncologists are well positioned to apply principles of palliative
care when caring for these patients by delivering primary palliative care and
appropriately referring complex patients for specialty palliative care
services. Yet, integration in this regard has been lacking. Consequently, RT is
often fraught with misaligned values, unrecognized treatment burdens, and
unrealistic expectations of cure. My goal is to become an independent
clinician-investigator at the intersection of palliative care and radiation
oncology whose work improves the care of advanced cancer patients undergoing
palliative RT. In this proposal I outline a focused research project,
mentorship plan, and career development plan to catalyze my development into an
independent investigator working to integrate palliative care practice
principles into radiation oncology. I plan to perform a combined
qualitative-quantitative investigation involving: (1) qualitative interviews
with advanced cancer patients treated with palliative RT in the Mount Sinai
Health System exploring treatment-related expectations, side effects and other
burdens, and preferences for palliative care services around RT, (2)
qualitative interviews with radiation oncologists to ascertain providers’
perceptions of palliative care and barriers and facilitators to its delivery
within radiation oncology, and (3) quantitative analyses of referral patterns
to specialist palliative care among palliative RT patients. Findings and
research skills acquired during the award period will inform development of a
K23 application in which I design and pilot test interventions to enhance
radiation oncologists’ provision of broader palliative care services in
conjunction with palliative RT. These strategies will ultimately be vetted and
disseminated through an R01-funded clinical trial that aims to improve outcomes
for patients with advanced-stage cancer who undergo palliative RT.
Bio
Kavita Dharmarajan, MD, MSc is an Assistant Professor in the
Department of Radiation Oncology and the Brookdale Department of Geriatrics and
Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York
City. She earned a Bachelor of Arts degree from the University of Texas at
Austin followed by a Master’s degree in health population science from the
London School of Economics and a medical degree from Columbia University
College of Physicians and Surgeons. Kavita completed her residency training at
Massachusetts General Hospital and Memorial Sloan-Kettering Cancer
Center. She was awarded an American Medical Association Foundation Grant
for Outstanding Young Investigators to study shared decision-making for
palliative radiation patients in 2012. In 2013, she received the Roentgen
Research Award from the Radiological Society of North America. In 2015, she was
selected as an AAHPM Research Scholar. Her primary research interests include
improving access to palliative care for advanced cancer patients receiving
radiation therapy as well as facilitating better communication and informed
decision-making among advanced cancer patients, caregivers, and physicians.
Email: kavita.dharmarajan@mountsinai.org