Trends in the Aggressiveness of End-of-Life Care for Advanced Stomach Cancer Patients

Abstract

PurposeIt is important to balance the appropriateness of active cancer treatments and end-of-life care to improve the quality of life for terminally ill cancer patients. This study describes the treatment patterns and end-of-life care in terminal gastric cancer patients.Materials and MethodsWe retrospectively analyzed the records of 137 patients with advanced gastric cancer receiving chemotherapy and dying between June 1, 2006 and May 31, 2011. We recorded interval between last chemotherapy dose and death; frequency of emergency room visits or admission to the intensive care unit in the last month before death; rate of hospice referral and agreement with written do-not-resuscitate orders; and change in laboratory values in the last three months before death.ResultsDuring the last six months of life, 130 patients (94.9%) received palliative chemotherapy; 86 (62.7%) during the final two months; 41 (29.9%) during the final month. During the final month, 53 patients (38.7%) visited an emergency room more than once; 21 (15.3%) were admitted to the intensive care unit. Hospice referral occurred in 54% (74 patients) of the patients; 93.4% (128 patients) gave written do-not-resuscitate orders. Platelets, aspartate aminotransferase and creatinine changed significantly two weeks before death; total bilirubin, one month before; and C-reactive protein, between four and two weeks before death.ConclusionOur results demonstrated that a significant proportion of gastric cancer patients received palliative chemotherapy to the end of life and the patients who stopped the chemotherapy at least one month before death had a lower rate of intensive care unit admission and longer overall survival than those who sustained aggressive chemotherapy until the last months of their lives.

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“…It also allows for patients and physicians to initiate advance care planning, and to discuss the continuation or discontinuation of life-prolonging treatments. Yet, recent studies have reported trends towards a rising aggressiveness of cancer care in the last months and weeks before death, [28][29][30][31][32] with sizable economic consequences. 33,34 However, very little is known about the use of care and treatments in the last months of life of patients with metastatic melanoma.…”

“…It also allows for patients and physicians to initiate advance care planning, and to discuss the continuation or discontinuation of life‐prolonging treatments. Yet, recent studies have reported trends towards a rising aggressiveness of cancer care in the last months and weeks before death, with sizable economic consequences …”

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