Chemotherapy use at the End of Life. A Retrospective Single Centre Experience Analysis

Andreis, Federica; Rizzi, Anna; Rota, Luigina; Meriggi, Fausto; Mazzocchi, Maria; Zaniboni, Alberto

doi:10.1177/030089161109700106

Cited by 26 publications

(17 citation statements)

References 20 publications

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“…However, the proportion of terminal cancer patients receiving palliative chemotherapy in the last six months of life is much higher than in the United States where Emanuel et al [10] reported a rate of 26-33% in 2003. The proportion of the use of palliative chemotherapy in metastatic or advanced solid cancer patients in the last two weeks of life has been decreasing (18.5% in North America in 2004, 8% in Australia in 2009, and 6% in Italy in 2011) [11-13]. However, in our study, the use of palliative chemotherapy in the last two weeks of life was 9.5%, still higher than in other countries.…”

Section: Discussioncontrasting

confidence: 50%

Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

2013

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PurposeIt is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients. This study describes the treatment patterns and end-of-life care in terminal gastric cancer patients.Materials and MethodsWe retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded interval between last chemotherapy dose and death; frequency of emergency room visits or admission to the intensive care unit in the last month before death; rate of hospice referral and agreement with written do-not-resuscitate orders; and change in laboratory values in the last three months before death.ResultsDuring the last six months of life, 130 patients (94.9%) received palliative chemotherapy; 86 (62.7%) during the final two months; 41 (29.9%) during the final month. During the final month, 53 patients (38.7%) visited an emergency room more than once; 21 (15.3%) were admitted to the intensive care unit. Hospice referral occurred in 54% (74 patients) of the patients; 93.4% (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly two weeks before death; total bilirubin, one month before; and C-reactive protein, between four and two weeks before death.ConclusionOur results demonstrated that a significant proportion of gastric cancer patients received palliative chemotherapy to the end of life and the patients who stopped the chemotherapy at least one month before death had a lower rate of intensive care unit admission and longer overall survival than those who sustained aggressive chemotherapy until the last months of their lives.

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Section: Discussioncontrasting

confidence: 50%

Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

2013

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“…Other parameters were described less frequently as being associated with near-death chemotherapy: symptomatic disease, poor ECOG PS, dying in a small hospital (<1000 beds) 66 70. On the other hand, to be included in a therapeutic trial did not seem to influence the interval between chemotherapy and death 59. Less invasive oral treatments (targeted therapies, chemotherapies), often better tolerated, can easily be maintained at the EOL 74.…”

Section: Resultsmentioning

confidence: 99%

“…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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“…(a) Disease and clinical factors: Key factors in decisions to stop treatment included worsening patient condition or functional status [ 10 , 38 , 43 , 44 , 49 , 52 , 55 , 57 – 60 ] disease progression or advanced stage disease [ 9 , 38 , 40 , 43 , 44 , 47 , 49 , 52 , 57 , 60 ] and treatment side effects [ 7 , 38 , 49 , 52 , 55 , 59 – 61 ]. Patients who received their diagnosis when only in advanced disease, and patients who had not received treatment earlier in the course of illness for other reasons, often had their therapy extended much longer than patients who had received earlier treatments [ 5 , 38 , 62 – 65 ].…”

Section: Resultsmentioning

confidence: 99%

Withdrawal of anticancer therapy in advanced disease: a systematic literature review

et al. 2015

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BackgroundCurrent guidelines set out when to start anticancer treatments, but not when to stop as the end of life approaches. Conventional cytotoxic agents are administered intravenously and have major life-threatening toxicities. Newer drugs include molecular targeted agents (MTAs), in particular, small molecule kinase-inhibitors (KIs), which are administered orally. These have fewer life-threatening toxicities, and are increasingly used to palliate advanced cancer, generally offering additional months of survival benefit. MTAs are substantially more expensive, between £2-8 K per month, and perceived as easier to start than stop.MethodsA systematic review of decision-making concerning the withdrawal of anticancer drugs towards the end of life within clinical practice, with a particular focus on MTAs. Nine electronic databases searched. PRISMA guidelines followed.ResultsForty-two studies included. How are decisions made? Decision-making was shared and ongoing, including stopping, starting and trying different treatments. Oncologists often experienced ‘professional role dissonance’ between their self-perception as ‘treaters’, and talking about end of life care. Why are decisions made? Clinical factors: disease progression, worsening functional status, treatment side-effects. Non-clinical factors: physicians’ personal experience, values, emotions. Some patients continued treatment to maintain ‘hope’, often reflecting limited understanding of palliative goals. When are decisions made? Limited evidence reveals patients’ decisions based upon quality of life benefits. Clinicians found timing withdrawal particularly challenging. Who makes the decisions? Decisions were based within physician-patient interaction.ConclusionsOncologists report that decisions around stopping chemotherapy treatment are challenging, with limited evidence-based guidance outside of clinical trial protocols. The increasing availability of oral MTAs is transforming the management of incurable cancer; blurring boundaries between active treatment and palliative care. No studies specifically addressing decision-making around stopping MTAs in clinical practice were identified. There is a need to develop an evidence base to support physicians and patients with decision-making around the withdrawal of these high cost treatments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1862-0) contains supplementary material, which is available to authorized users.

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Chemotherapy use at the End of Life. A Retrospective Single Centre Experience Analysis

Cited by 26 publications

References 20 publications

Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

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

Withdrawal of anticancer therapy in advanced disease: a systematic literature review

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