Characterization of patients receiving palliative chemo- and radiotherapy during end of life at a regional cancer center in Norway

Abstract

Background. Many cancer patients receive chemotherapy and radiotherapy their last 30 days [end of life (EOL)]. The benefi t is questionable and side effects are common. The aim of this study was to investigate what characterized the patients who received chemo-and radiotherapy during EOL, knowledge that might be used to improve practice. Methods. Patients dead from cancer in 2005 and 2009 were analyzed. Data were collected from hospital medical records. When performance status (PS) was not stated, PS was estimated from other information in the records. A Glasgow Prognostic Score (GPS) of 0, 1 or 2 was assessed from blood values (CRP and albumin). A higher score is associated with a shorter prognosis. Results. In total 616 patients died in 2005; 599 in 2009. Among the 723 analyzed, median age was 71; 42% had metastases at diagnosis (synchronous metastases); 53% had PS 2 and 16% PS 3 -4 at the start of last cancer therapy. GPS at the start of last cancer therapy was assessable in 70%; of these, 26% had GPS 1 and 35% GPS 2. Overall, 10% received chemotherapy and 8% radiotherapy during EOL. The proportions varied signifi cantly between the different types of cancer. Multivariate analyses revealed that those at age Ͻ 70 years, GPS 2, no contact with our Palliative Care Unit and synchronous metastases received most chemotherapy the last 30 days. PS 3 -4, GPS 2 and synchronous metastases were strongest associated with radiotherapy the last 30 days. Conclusion. Ten percent received chemotherapy and 8% radiotherapy the last 30 days of life. GPS 2 and synchronous metastases were most signifi cantly associated with cancer therapy the last 30 days of life, indicating that in general, patients with the shortest survival time after diagnosis of cancer received more chemo-and radiotherapy during EOL than other patients.

Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research

“…In this study, 15% who died within 1 month after inclusion received chemotherapy, relative to 10% and 18% in other studies 30 33. These numbers still indicate a need for discussion and a potential for improvement.…”

“…However, the use of anti-neoplastic therapy in an acute PCU was investigated26 and it was concluded that this was limited to a small percentage of patients and was associated with characteristics such as younger age, female sex and cancer diagnoses, similar to findings in a Norwegian study 30…”

Palliative radiotherapy (PRT) during the last month of life: A constant sorrow even in a dedicated PRT facility with research focus on this endpoint

“…Given that short-course PRT regimens with no or minimal side effects exist, which nevertheless often improve symptoms, clinicians are afraid of withholding a meaningful therapeutic measure. In agreement with our findings [2], Anshushaug et al also reported that ECOG PS 3-4 was strongly associated with PRT during the last month of life [4], but other factors also play a role. Given consistent reports from different countries, should we regard 30DM of 615% as unavoidable and acceptable?…”

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

“…In this regard, Anshushaug et al (19) also observed that ECOG PS 3/4 was strongly associated with palliative radiotherapy during the last month of life. The impact of performance status as a prognostic factor in patients with brain metastases is well known (20).…”