End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy

Formoso, Giulio; Marino, Massimiliano; Guberti, Monica; Grilli, Roberto

doi:10.1136/bmjopen-2021-057437

Cited by 6 publications

(12 citation statements)

References 51 publications

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“…Based on the analysis of SEER-Medicare, an overly aggressive care is associated with more than 10% of patients receiving SAT in the last 14 days (40). As for the patients who received SAT within 30 or 60 days, our results are in line with those reported in the literature in Italy (41,42) and in other countries (43)(44)(45). Although the use of SAT in patients who are close to death has been increasing over time (46), little information is available about the clinical effect of such treatment (47).…”

Section: Discussionsupporting

confidence: 92%

Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients

et al. 2022

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BackgroundEarly activation of palliative care for patients with advanced cancer is central in the treatment trajectory. At the Veneto Institute of Oncology, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients are evaluated by an oncologist together with a palliative care team. Recently, we reported on consecutive patients admitted at SCOC from 2018 to 2021 in terms of appropriateness, process, and outcome indicators. Here, we report further analysis in the same group of 753 patients, evaluating other parameters and the correlation between symptom intensity, gender, age, and survival.MethodsSCOC data were retrieved from a prospectively maintained database.ResultsAmong the patients, 42.2% were women, and the median age was 68 years, with 46.7% of patients aged ≥70 years. The most prevalent disease type was gastrointestinal cancer (75.2%), and 90.9% of the patients had metastatic disease. The median score for the distress thermometer was 4; the vast majority of the patients (98.6%) reported physical problems, and 69.4% presented emotional issues. Younger women demonstrated a significantly greater median distress than other patients (p=0.0018). Almost all symptoms had a higher prevalence on the 0–3 Edmonton Symptom Assessment Scale (ESAS) score, except for fatigue. About 43.8% of the patients received systemic anticancer treatment (SAT) in the last 60 days of life, 15.0% of whom received SAT in the last month and 3.1% in the last 2 weeks. For some symptoms, women frequently had more ESAS >3. Pain and nausea were significantly less reported by older patients compared with younger adults. Men had a lower risk of having MUST score ≥ 2 (p=0.0311). Men and older patients showed a lower prognosis awareness (p=0.0011 and p=0.0049, respectively). Older patients received less SAT within the last 30 days of life (p=0.0006) and had death risk decreased by 20.0%.ConclusionOur study identified two subgroups of patients with advanced cancer who require special attention and support due to important symptoms’ burden detected by Patient Reported Outcome Measures tests: women and younger adults. These categories of patients require special attention and should be provided early access at SCOC. The role of an oncologist remains crucial to intercept all patients in need of early palliative care and balancing trade-offs of anticancer treatment in advanced metastatic disease.

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Section: Discussionsupporting

confidence: 92%

Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients

et al. 2022

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“…A psycho-oncology service has been operating for many years in the region [ 24 ]. Specific psychological support services are usually integrated within hospital cancer units [ 25 ] and home palliative care units [ 26 ]. In addition, a consultation liaison psychiatric service for primary care is available to support general practitioners, usually treating individuals with milder clinical conditions.…”

Section: Methodsmentioning

confidence: 99%

Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study

Chierzi¹,

Stivanello²,

Musti³

et al. 2022

Soc Psychiatry Psychiatr Epidemiol

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Purpose Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. Methods We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008–2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. Results Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78–1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01–2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. Conclusion Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

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“…Ninety-six started chemotherapy at a median of 36 (IQR 25-42) days and stopped at a median of 33 days (IQR 21-41) before death. Thirty patients started chemotherapy at a median of 18 days (IQR [12][13][14][15][16][17][18][19][20][21][22][23][24][25], with discontinuation at a median of 15 (IQR 10-21) days before death. Breakdown per group is reported in Table 2.…”

Section: Conventional Chemotherapy In the Last 3 Monthsmentioning

confidence: 99%

“…Overall, 177 (29%) patients received anticancer therapy in the last 3 months of life (intervention: 79 [45%], control: 98 [55%]). Median time from diagnosis until death was 6 months (IQR [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The majority (35%) had pancreatic cancer.…”

Section: Use Of Anticancer Therapy In the Last 3 Monthsmentioning

confidence: 99%

“…4,9 No RCTs on integration of oncology and specialised palliative care use anticancer therapy as the primary endpoint, despite reported associations with poorer quality of life and hastened death 2 and although indices of less use have been reported as secondary outcomes. 10,11 Most publications on end-of-life anticancer therapy are retrospective cohort analyses from single-or multi-institutional studies 2,9,12,13 or registry reports 8,[14][15][16] suggesting that palliative care and patient-centred care may reduce aggressive end-of-life treatment.…”

Section: Introductionmentioning

confidence: 99%

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PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life

Hjermstad,

Pirnat,

Aass

et al. 2024

Palliat Med

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Background: Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. Aim: To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. Design: Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used. Setting: A total of 12 Norwegian hospitals (03/2017–02/2021). Participants: Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months. Results: A total of 616 (93%) patients were included (intervention: 309/control:307); 63% males, median age 69, 77% had gastrointestinal cancers. Median survival time from inclusion was 8 (IQR 3–14) and 7 months (IQR 3–12), and days between anticancer therapy start and death were 204 (90–378) and 168 (69–351) (intervention/control). Overall, 78 patients (13%) received anticancer therapy in the last month (intervention: 33 [11%]/control: 45 [15%]). No differences were found in patient-reported outcomes. Conclusion: We found no significant differences in the probability of receiving end-of-life anticancer therapy. The intervention did not have the desired effect. It was probably too general and too focussed on communication skills to exert a substantial influence on conventional clinical practice.

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End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy

Cited by 6 publications

References 51 publications

Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients

Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients

Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study

PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life

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