Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Abstract

Introduction. Although palliative chemotherapy during end‐of‐life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end‐of‐life care and less use of hospice service. This is a population‐based study of the association between palliative chemotherapy and aggressiveness of end‐of‐life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2–6 months before death were included. Aggressiveness of end‐of‐life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end‐of‐life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician's specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p < .001), more than one intensive care unit admission (p < .001), and endotracheal intubation (p = .02) during end‐of‐life care were significantly more common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p < .001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end‐of‐life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. Implications for Practice: Palliative chemotherapy is used for patients with incurable cancer toward the end of life (EOL). Aggressiveness of EOL care and hospice care are related to the quality of life of these patients. This study of data from the Taiwanese National Health Insurance Research Database found that palliative chemotherapy led to more aggressive EOL care and less hospice care. There is a need to provide patients with terminal cancer access to care information that best meets their needs, especially those patients who receive palliative chemotherapy.

Impact of Palliative Care on Quality of End-of-Life Care Among Brazilian Patients With Advanced Cancers

“…Similarly, palliative chemotherapy was considered an indicator of more aggressive EOL care. 13,28 This may be attributed to increased toxicities caused by administration of chemotherapy, which consequently provides medical interventions, emergency department visits, and hospitalizations for management and control of toxicities. 13,28 In randomized trials, advanced cancer patients who received early PC also reported less aggressive EOL.…”

“…13,28 This may be attributed to increased toxicities caused by administration of chemotherapy, which consequently provides medical interventions, emergency department visits, and hospitalizations for management and control of toxicities. 13,28 In randomized trials, advanced cancer patients who received early PC also reported less aggressive EOL. 16e18, 25,29 The results of the present study did not show significantly improved quality EOL care between early and late PC.…”

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

“…15 16 Among them, the most frequently analysed were recourse to chemotherapy during the last 14 or 30 DOL and ED visits during the last 30 DOL. A growing body of data suggests that less use of palliative versus active chemotherapy for patients recognised as having short life expectancy or more frequent EOL discussions with them might reduce intensive EOL care and promote earlier access to palliative care, thereby improving the quality of EOL care of patients with advanced cancer 14–16 23 29 31 49 61 64. Moreover, it was shown that EOL discussions might be particularly important for patients receiving palliative chemotherapy, who should be informed by substantiated scientific data of the likely outcomes associated with its use 64 88.…”

“…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…”

The impact of initial treatment strategy and survival time on quality of end-of-life care among patients with oesophageal and gastric cancer: A population-based cohort study

“…A French study found that 77% of patients with advanced oesophageal and gastric cancer died in hospital, and that 8% of these patients received chemotherapy during the final week of life [28]. Treatment with surgery [25] or chemotherapy [29] is associated with underuse of palliative care in terms of palliative care consultation [30,31] and late hospice referral [32]. This indicates that treatment characteristics may influence the quality of EOL care, and should thus be taken into account in order to understand barriers to high quality of care.…”