Palliative cancer therapy during end of life at a regional cancer center in Norway in 2005 and 2009.

Abstract

9040 Background: With increasing number of available therapies, there is a risk that patients (pts) are overtreated. Palliative cancer therapy is mostly recommended for pts with good Performance Status (PS). In one study, 42 % of pts received chemotherapy (CTx) during the last 30 days of life – suggesting that this may not always be the case. Methods: All pts who, according to the national registry, died from cancer in our region in 2005 and 2009 were analyzed. Data were collected from individual medical records. Endpoints: Time from the end of palliative cancer therapy until death. Whether there were differences depending on age; type of cancer; year of death or if they were seen at a palliative care unit (PCU). PS when the last cancer therapy was initiated. Results: 616 pts died in 2005; 599 in 2009. We excluded 495 pts: No cancer therapy (n=260); no information of cancer (n=101); last therapy with curative intention (n=83); hematological malignancy (n=51). Median age 71 (6 - 99); 49 % men; median overall survival from diagnosis: 16.9 mos. Last therapy was radiotherapy (RT): 31 %; CTx: 40 %; hormonal: 15 %; surgery: 11 %. 4 % died from treatment complications. Median time from start of last CTx or RT until death: 100 days; from end of last CTx or RT: 63 days. Younger pts received more CTx and RT in the last 30 days: Age < 60: 28 %; 60-70: 23 % and 70+: 12 % (p<.001). The table shows the use of CTx and RT the last 30 and 14 days for the most common cancers. Among those who got CTx in the last 30 days (n=74); 54 % had PS 2; 14 % PS 3-4. Among those who got RT in the last 30 days (n=61), 31 % had PS 2; 54 % PS 3-4. Of the 49 % referred to the PCU, fewer received CTx or RT in the last 30 days (PCU: 14 %, no PCU: 22 %; p=.002) and 14 days (PCU: 5 %, no PCU: 12 %; p<.001). Conclusions: Many pts received cancer therapy the last month of life. The percentage varies with age, cancer type and was lower in 2009 than in 2005. Pts seen at the PCU received less CTx and RT. Many pts had a poorer PS at the start of last cancer therapy than recommended. [Table: see text]