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

Rautakorpi, Liisa; Seyednasrollah, Fatemeh; Mäkelä, Johanna; Hirvonen, Outi; Laitinen, Tarja; Elo, Laura L.; Jyrkkiö, Sirkku

doi:10.1080/0284186x.2017.1332424

Cited by 12 publications

(15 citation statements)

References 17 publications

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“…In this study, 20% of the patients received systemic cancer treatment during the last month of life. This was in line with another Finnish study [16] where 18% of the patients received IV chemotherapy during the last month. The corresponding figures during the last two weeks of life were 18% in this study and 7% in the study by Rautakorpi et al [16].…”

Section: Impact Of Pc Decision On Cancer Treatments In Eolsupporting

confidence: 91%

“…A PC decision was more likely to be made for older patients with the threshold being patients over 80 years of age. In a previous Finnish study [16], patients under the age of 50 were more likely to receive IV chemotherapy during the last months and weeks of life compared to older patients. Likewise, Braga et al [7] have shown the increased probability of younger patients receiving chemotherapy during the last three months of life.…”

Section: Frequency and Timing Of Pc Decisionmentioning

confidence: 81%

“…The utilization of EOL chemotherapy and radiotherapy has previously been investigated [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], but there are no studies on the impact of PC decision-making and timing on anti-cancer treatments at the EOL.…”

Section: Introductionmentioning

confidence: 99%

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Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study

Hirvonen

Leskelä²,

Grönholm

et al. 2019

Acta Oncologica

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Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life. Material and methods: Patients with a cancer diagnosis treated in tertiary hospital during 1st January 2013-31st December 2014 and deceased by the end of 2014 were identified in the hospital database (N ¼ 2737). Of these patients, 992 were randomly selected for this study. The PC decision was screened from patient records, i.e., termination of cancer-specific treatments and a focus on symptom-centered PC. Results: The PC decision was defined in 82% of the patients during the last year of life (49% >30 days and 33% 30 days before death, 18% with no decision). The median time from the decision to death was 46 days. Systemic cancer therapy was given during the last month of life in 1%, 36% and 38% (p < .001) and radiotherapy 22%, 40% and 31% (p ¼ .03) cases, respectively; referral to a PC unit was made in 62%, 22% and 11%, respectively (p < .001). In logistic regression analyses younger age, shorter duration of the disease trajectory and type of cancer (e.g., breast cancer) were associated with a lack or late timing of the PC decision. Conclusion: The decision to initiate a palliative goal for the treatment was frequently made for cancer patients but occurred late for every third patient. Younger age and certain cancer types were associated with late PC decisions, thus leading to anti-cancer treatments continuing until close to the death with low access to a PC unit.

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Section: Impact Of Pc Decision On Cancer Treatments In Eolsupporting

confidence: 91%

Section: Frequency and Timing Of Pc Decisionmentioning

confidence: 81%

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Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study

Hirvonen

Leskelä²,

Grönholm

et al. 2019

Acta Oncologica

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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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“…In a previous study of aggressive end-of-life care that included approximately 1500 patients with metastatic prostate cancer younger than age 65 years, slightly more than 10% received chemotherapy within the last 14 days of life (17). This quality-of-care indicator, together with other endpoints, has repeatedly been reported in a broad range of oncology studies(26)(27)(28). Reducing overly aggressive end-of-life care is warranted from a patient, caregiver/family and payer/health-care administrator perspective.…”

mentioning

confidence: 88%

Initiation of Systemic Therapy During the Last 30 Days of Life in Patients With Metastatic Castration-resistant Prostate Cancer

et al. 2018

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versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol 16: 152-160, 2015. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med 367: 1187-1197, 2012. 11 6 Loriot Y, Miller K, Sternberg CN, Fizazi K, De Bono JS, Chowdhury S, Higano CS, Noonberg S, Holmstrom S, Mansbach H, Perabo FG, Phung D, Ivanescu C, Skaltsa K, Beer TM and Tombal B: Effect of enzalutamide on health-related quality of life, pain, and skeletal-related events in asymptomatic and minimally symptomatic, chemotherapy-naive patients with metastatic castration-resistant prostate cancer (PREVAIL): results from a randomised, phase 3 trial. Lancet Oncol 16: 509-521, 2015. 7 Oh WK, Miao R, Vekeman F, Sung J, Cheng WY, Gauthier-Loiselle M, Dhawan R and Duh MS: Patient characteristics and overall survival in patients with postdocetaxel metastatic castration-resistant prostate cancer in the community setting. emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med 369: 213-223, 2013. 9 Norum J, Traasdahl ER, Totth A, Nieder C and Olsen JA: Health economics and radium-223 (Xofigo®) in the treatment of metastatic castration resistant prostate cancer (mCRPC). A case history and a systematic review of the literature. Glob J Health Sci 8: 1-9, 2015. 10 Norum J and Nieder C: Treatments for metastatic prostate cancer (mPC): A review of costing evidence. Fujisawa M: Activity of cabazitaxel in patients with metastatic castrationresistant prostate cancer after treatment with single or dual regimens of novel androgen receptor-targeting agents. Med Oncol 34: 163, 2017. 14 Ghatalia P, Pond GR, Templeton AJ and Sonpavde G: Effect of single-agent daily prednisone on outcomes and toxicities in metastatic castration-resistant prostate cancer: Pooled analysis of prospective studies. Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014. PLoS One 12: e0175124, 2017. 13 17 Falchook AD, Dusetzina SB, Tian F, Basak R, Selvam N and Chen RC:Aggressive end-of-life care for metastatic cancer patients younger than age 65 years.

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

Cited by 12 publications

References 17 publications

Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study

Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study

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

Initiation of Systemic Therapy During the Last 30 Days of Life in Patients With Metastatic Castration-resistant Prostate Cancer

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