Chemotherapy in the last 30 days of life of advanced cancer patients

Pacetti, Paola; Paganini, Giovanni; Orlandi, M.; Mambrini, Andrea; Pennucci, M.C.; Freo, A. Del; Cantore, Maurizio

doi:10.1007/s00520-015-2733-6

Cited by 48 publications

(58 citation statements)

References 24 publications

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“…Comparison between the reports is, however, somewhat challenging, as the health care systems, study designs, and inclusion criteria vary between the studies. Studies with different focuses that estimate the aggressiveness of the treatment at one month before death frequently reported higher percentages (22-56%) [9][10][11][12][13][14] than what was observed in the present study, with the exception of the Australian (19%), Swiss (12%) and Norwegian cohorts (10%) [15][16][17]. However if we include all deceased cancer patients instead of the ones treated during the last year of life, the percentage in our study is distinctly lower, 5.2%.…”

Section: Discussionmentioning

confidence: 99%

End-of-life chemotherapy use at a Finnish university hospital: a retrospective cohort study

et al. 2017

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During the period of 9 years, the pattern of EOL IV chemotherapy treatment remained stable. Every third patient died at tertiary care. Only 7.2% of patients who received IV chemotherapy during the last year of life were treated 14 days before death, which is in line with international recommendations. However, significant variation in EOL treatment strategies between different diagnosis and age groups were identified.

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Section: Discussionmentioning

confidence: 99%

End-of-life chemotherapy use at a Finnish university hospital: a retrospective cohort study

et al. 2017

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“…That step identified 150 references. The second step was restricted to articles analysing—at least in part—lung cancers, excluding case reports and general reviews; it found 42 publications examining one or several indicators of EOL-care aggressivity of patients with lung cancer that were read in their entirety 11 14 16 23–65…”

Section: Methodsmentioning

confidence: 99%

Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care

Bylicki

Didier

Rivière

et al. 2019

BMJ Support Palliat Care

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ObjectivesDespite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time.MethodsA systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000–20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death.ResultsAmong the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care.ConclusionsOur analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.

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“…The Danish study also reported a death rate within 14 or 30 days of radiotherapy of 5.5 and 9.3% respectively . Rates of intervention close to death have also been shown to be influenced by tumour type, treating physician and age, prior treatment and performance status …”

Section: Introductionmentioning

confidence: 97%

Population‐based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia

Pitson

Matheson

Garrard

et al. 2020

Internal Medicine Journal

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Background: Cancer treatment near end of life is not likely to add meaningful benefit and minimising intervention rates has been promoted as an indicator of quality of care. Population-based analysis of treatment allows comparative analysis of treatment rates and provides insight into patterns of care.Aims: To report a population-based analysis of both radiotherapy and active systemic therapy (AST) delivery rates along with patterns of treatment within the last 14 and 30 days of life.Methods: The Evaluation of Cancer Outcomes Registry records clinical information on all newly diagnosed cancer patients for the Barwon South West Region of Victoria, Australia. Diagnosis details, tumour type and stage as well as core treatment details and date of death were extracted for all patients diagnosed from 2009 to 2015 inclusive.Results: A total of 12 760 cases cancers were recorded. The median age of all cases was 68.8, and 53% were male. AST was received by 3699 (29%) of patients and radiotherapy by 3811 (30%). Patient deaths within 14 and 30 days of treatment for AST were 4.3 and 8.7%, respectively, and deaths within 14 and 30 days of treatment for radiotherapy 3.8 and 8.0% respectively. Factors associated with death within 30 days of AST and/or radiotherapy were male gender, age greater than 70 years and higher disease stage (all P < 0.01). Treatment rates within 30 days of death were highest for lung cancer (23% of cases) and lowest for breast cancer (2% of cases). Conclusions:This population-based analysis of AST and radiotherapy treatment within the last 30 days of life within a region of Australia has shown overall treatment rates below 10%. Treatment rates appear influenced by both patient and tumour characteristics. Future focus on subgroups with high rates of late intervention may help minimise treatment unlikely to add benefit. PC Ref/dead (%) PC Ref/alive (%) P-value Any treatment 30-day outcomes 317/608 (52) 1207/5190 (23) <0.01 Any treatment 14-day outcomes 135/299 (45) 1403/5595 (25) <0.01 Radiotherapy 30-day outcomes 184/309 (60) 878/3502 (25) <0.01 Radiotherapy 14-day outcomes 76/147 (52) 986/3664 (27) <0.01 Active systemic therapy 30-day outcomes 142/323 (44) 827/3376 (25) <0.01 Active systemic therapy 14-day outcomes 63/160 (39) 906/3539 (26) <0.01Population-based end-of-life care review

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Chemotherapy in the last 30 days of life of advanced cancer patients

Cited by 48 publications

References 24 publications

End-of-life chemotherapy use at a Finnish university hospital: a retrospective cohort study

End-of-life chemotherapy use at a Finnish university hospital: a retrospective cohort study

Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care

Population‐based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia

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