End-of-Life Care of Women With Gynecologic Malignancies: A Pilot Study

Abstract

Objective There is limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in last six months of life. Patient demographics, patterns of care and utilization of palliative medicine consultation services were evaluated. Methods 100 patients who died from gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within one year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record and analyses were made using Students T, and Mann-Whitney testing with SPSS software. Results The mean age of patients was 60 years (range 30–94 years). Racial/ethnic distribution was 38% Caucasian, 34% Black, and 15% Hispanic. 75% of patients received chemotherapy within the last six months of life, 30% received chemotherapy within the last six weeks of life. The median number of days hospitalized during the last six months of life was 24 (range 0–183 days). During the last six months of life, 19% were admitted to the Intensive Care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardio-pulmonary resuscitative efforts. 64% had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had ≥ 14 days from consultation until death versus patients who had ≤ 14 days or no consultation, 21 (72%) versus 29 (41%), p =0.004. Patients who were single were less likely to have a palliative medicine consultation, p=0.005. Conclusions End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality-of-life. These pilot data suggest that factors for implementation of timely hospice referral, family support and legacy building should include specialists trained in palliative medicine.

Chemotherapy and healthcare utilisation near the end of life in patients with cancer

“…Nevertheless, our findings are in line with prior research, which has shown that treatment towards the end of life is becoming more aggressive over time (Earle et al, 2008 Gibbons, Hutchins, & Green, 2008) to 76% within 6 weeks of death (Nevadunsky et al, 2013). Due to differences in healthcare systems around the world, data about healthcare utilization (e.g.…”

“…One review demonstrated that the prevalence of non-beneficial treatment at the end-of-life in patients with cancer ranged from 33% to 38% (Cardona-Morrell et al, 2016). Reported rates of the start of chemotherapy at the end of life ranged from 8.8% within 14 days of death (Von Gruenigen, Daly, Gibbons, Hutchins, & Green, 2008) to 76% within 6 weeks of death (Nevadunsky et al, 2013). Due to differences in healthcare systems around the world, data about healthcare utilization (e.g.…”

Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic cancers

“…Both rates were below the 10% considered as a quality criterion of an oncology service [26]. Previous retrospective studies have reported active treatment rates in the last 4 weeks of life ranging from 23% to 55.6% [8,9,[27][28][29]. Some characteristics increase the chances of the patient receiving chemotherapy in the last month of life, such as being a young woman, having a chemo-responsive tumor, and being treated in a small oncology service [28].…”

“…Women with advanced breast or gynecologic cancers (ABGCs) tend to receive more palliative chemotherapy at the end of life [8]. A previous study [9] found that 30% of women with gynecologic malignancies received chemotherapy in the last 6 weeks of life. Many invasive and unnecessary treatments were observed in the last 6 months of life, which most likely negatively impacted the QoL of these patients [10].…”

Prevalence of resuscitation in cancer patients at the end of life—a population-based observational study from Germany

“…The published literature only includes a few studies on the prevalence of CPR in patients with terminal cancer (14,(17)(18)(19)(20)(21)(22)(23)(24)(25), and a large proportion of the data refer to hospital patients (17)(18)(19)(20)(21). The CPR prevalence vary widely (3.2-39.0%) depending on disease status, tumor entity, observation period, and in-hospital treatment setting.…”