End-of-Life Care for Patients With Advanced Ovarian Cancer Is Aggressive Despite Hospice Intervention

Chiang, Jui-Kun; Hsu, Chun-Shuo; Lin, Chih‐Wen; Kao, Yee-Hsin

doi:10.1097/igc.0000000000001285

Cited by 7 publications

(4 citation statements)

References 40 publications

(34 reference statements)

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“…The percentages for chemotherapy use in the last months of life in our cohort are lower than those reported in a large retrospective database study performed in the US including 5509 patients [6]. Several, mainly smaller, studies reported chemotherapy treatment in the last 14 days of life, with percentages varying between 5 and 13% [10][11][12][13][14][15], whereas it was 12% in the last month of life in our study. In a cohort of 110 Italian patients, a much higher percentage of chemotherapy use in the final 3 and last month of life (77% and 38% respectively) was reported [7].…”

Section: Discussioncontrasting

confidence: 88%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis

Broekman¹,

Aa²,

Nijman³

et al. 2022

Gynecologic Oncology

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Section: Discussioncontrasting

confidence: 88%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis

Broekman¹,

Aa²,

Nijman³

et al. 2022

Gynecologic Oncology

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Section: Discussioncontrasting

confidence: 88%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

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e17612 Background: Patients with advanced ovarian cancer have a poor prognosis and can experience debilitating abdominal symptoms in the last phase of life. Several analyses, mainly performed in the United States (US), show high rates of chemotherapy administration, and emergency room and hospital visits near the end-of-life in this patient category. No large European studies are available, while the organisation of palliative care differs between the US and Europe and between European countries. We aimed to analyse the intensity of inpatient care near the end-of-life in the Netherlands and perform a cross-study comparison with previous reports. Methods: All patients with ovarian cancer that died in 2016 and 2017 were identified from the database of the foundation Dutch Hospital Data (DHD). For the last six months of life the following parameters of aggressive care were extracted: administration of chemotherapy, emergency room (ER) visits, surgical procedures, hospital and intensive care unit (ICU) admissions. Data were analysed for the cohort as a whole and separately for three age categories: < 60, 60-75 and > 75 years of age. The intensity of inpatient care was compared to previously reported European and US data. Results: A total of 2172 patients died with ovarian cancer in 2016 and 2017 in the Netherlands. Data on medical care use was available for 1775 patients. During the last 6 months of life, chemotherapy was given to half of the ovarian cancer patients and the same percentage of patients was admitted to hospital. Chemotherapy administration near the end-of-life was infrequent, with only 12% of patients receiving chemotherapy in the last month of life. Surgery and ICU admissions in the final 6 months of life were rare (< 10%). Our cohort showed the lowest percentages of all five indicators of aggressive care reported thus far. The use of chemotherapy in the six months prior to death was highest in patients 60-75 years of age compared to younger or older patients. ER visits and hospital admissions were less frequent in patients > 75 years of age compared to the younger age groups. Conclusions: Aggressive medical care use in the final 6 months of life in this Dutch cohort of ovarian cancer patients was lower than in other previously reported cohorts.

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“…In this way, it may also reinforce the need to study care patterns and quality of life outcomes for young patients with advanced cancer. [55][56][57] Future work would benefit from harmonizing age cutoffs so that the literature can maintain consistency and thus reach more unified conclusions. 4 Furthermore, considering age as a continuum rather than predefined cutoff might be beneficial for future researches since a sharp dichotomy of CRC characteristics and prognosis at 50 years of age is unlikely.…”

Section: Demographics and Clinicopathologic Featuresmentioning

confidence: 99%

Care Patterns and Overall Survival in Patients With Early-Onset Metastatic Colorectal Cancer

Kanter

Fish

Mauri

et al. 2021

JCO Oncology Practice

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PURPOSE: Colorectal cancer (CRC) incidence in patients younger than 50 years of age, commonly defined as early-onset (EO-CRC), is rising. EO-CRC often presents with distinct clinicopathologic features. However, data on prognosis are conflicting and outcomes with modern treatment approaches for metastatic disease are still limited. MATERIALS AND METHODS: We prospectively enrolled patients with metastatic CRC (mCRC) to a biobanking and clinical data collection protocol from 2014 to 2018. We grouped the cohort based on age at initial diagnosis: < 40 years, 40-49 years, and ≥ 50 years. We used regression models to examine associations among age at initial diagnosis, treatments, clinicopathologic features, and survival. RESULTS: We identified 466 patients with mCRC (45 [10%] age < 40 years, 109 [23%] age 40-49 years, and 312 [67%] age ≥ 50 years). Patients < 40 years of age were more likely to have received multiple metastatic resections (odds ratio [OR], 3.533; P = .0066) than their older counterparts. Patients with EO-CRC were more likely to receive triplet therapy than patients > 50 years of age (age < 40 years: OR, 6.738; P = .0002; age 40-49 years: OR, 2.949; P = .0166). Patients 40-49 years of age were more likely to have received anti-EGFR therapy (OR, 2.633; P = .0016). Despite differences in care patterns, age did not predict overall survival. CONCLUSION: Despite patients with EO-CRC receiving more intensive treatments, survival was similar to the older counterpart. However, EO-CRC had clinical and molecular features associated with worse prognoses. Improved biologic understanding is needed to optimize clinical management of EO-CRC. The cost-benefit ratio of exposing patients with EO-CRC to more intensive treatments has to be carefully evaluated.

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End-of-Life Care for Patients With Advanced Ovarian Cancer Is Aggressive Despite Hospice Intervention

Abstract: The aggressiveness of EOL cancer care and healthcare costs could not be offset in the final month of life among women with advanced ovarian cancer who received hospice care. The factors of more hospitalizations and dying in hospital warrant further investigation.

Cited by 7 publications

References 40 publications

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Care Patterns and Overall Survival in Patients With Early-Onset Metastatic Colorectal Cancer

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