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Santero M, Requeijo C, Quintana MJ, Rodríguez D, Bottaro D, Macias I, Pericay C, Farina N, Blanco JM, Urreta-Barallobre I, Punti L, Nava MA, Bonfill Cosp X. How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study. Clin Transl Oncol 2024:10.1007/s12094-024-03436-1. [PMID: 38662169 DOI: 10.1007/s12094-024-03436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
AIM To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals. METHODS Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up. RESULTS We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life. CONCLUSION A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.
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Affiliation(s)
- Marilina Santero
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain.
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain.
- Centro Cochrane Iberoamericano, Barcelona, Spain.
| | - Carolina Requeijo
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Jesus Quintana
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - David Bottaro
- Hospital Universitari Sant Joan de Reus, Reus, Spain
| | | | | | | | | | - Iratxe Urreta-Barallobre
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Clinical Epidemiology, Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Laura Punti
- Clinical Epidemiology Unit, Osakidetza Basque Health Service, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Maria Angeles Nava
- Clinical Epidemiology Unit, Osakidetza Basque Health Service, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Xavier Bonfill Cosp
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Universitat Autònoma Barcelona (UAB), Barcelona, Spain
- Institut de Reserca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Hospital de Mataró, Mataró, Spain
- Centro Cochrane Iberoamericano, Barcelona, Spain
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Geyer T, Le NS, Groissenberger I, Jutz F, Tschurlovich L, Kreye G. Systemic Anticancer Treatment Near the End of Life: a Narrative Literature Review. Curr Treat Options Oncol 2023; 24:1328-1350. [PMID: 37501037 PMCID: PMC10547806 DOI: 10.1007/s11864-023-01115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/29/2023]
Abstract
OPINION STATEMENT Systemic anticancer therapy (SACT) includes different treatment modalities that can be effective in treating cancer. However, in the case of disease progression, cancers might become incurable and SACT might reach its limits. In the case of incurable cancers, SACT is often given in a palliative setting, with the goal of improving the patients' quality of life (QOL) and their survival. In contrast, especially for patients who approach end of life (EOL), such treatments might do more harm than good. Patients receiving EOL anticancer treatments often experience belated palliative care referrals. The use of systemic chemotherapy in patients with advanced cancer and poor prognosis approaching the EOL has been associated with significant toxicity and worse QOL compared to best supportive care. Therefore, the American Society of Clinical Oncology (ASCO) has discouraged this practice, and it is considered a metric of low-value care by Choosing Wisely (Schnipper et al. in J Clin Oncol 4;30(14):1715-24). Recommendations of the European Society for Medical Oncology (ESMO) suggest that especially chemotherapy and immunotherapy should be avoided in the last few weeks of the patients' lives. In this narrative review, we screened the current literature for the impact of SACT and factors predicting the use of SACT near the EOL with discussion on this topic.
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Affiliation(s)
- Teresa Geyer
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Nguyen-Son Le
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
- Division of Palliative Care, Department of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital of Krems, Mitterweg 10, 3500 Krems an Der Donau, Austria
| | - Iris Groissenberger
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Franziska Jutz
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Lisa Tschurlovich
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Gudrun Kreye
- Karl Landsteiner University of Health Sciences, Dr. Karl Dorrek-Straße 30, 3500 Krems an der Donau, Austria
- Division of Palliative Care, Department of Internal Medicine 2, Karl Landsteiner University of Health Sciences, University Hospital of Krems, Mitterweg 10, 3500 Krems an Der Donau, Austria
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Galiano A, Schiavon S, Nardi M, Guglieri I, Pambuku A, Martino R, Bolshinsky M, Murgioni S, Intini R, Soldà C, Marino D, Daniel F, De Toni C, Pittarello C, Chiusole B, Prete AA, Bimbatti D, Nappo F, Caccese M, Bergamo F, Brunello A, Lonardi S, Zagonel V. Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients. Front Oncol 2022; 12:989713. [PMID: 36313660 PMCID: PMC9614371 DOI: 10.3389/fonc.2022.989713] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/05/2022] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Early activation of palliative care for patients with advanced cancer is central in the treatment trajectory. At the Veneto Institute of Oncology, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients are evaluated by an oncologist together with a palliative care team. Recently, we reported on consecutive patients admitted at SCOC from 2018 to 2021 in terms of appropriateness, process, and outcome indicators. Here, we report further analysis in the same group of 753 patients, evaluating other parameters and the correlation between symptom intensity, gender, age, and survival. METHODS SCOC data were retrieved from a prospectively maintained database. RESULTS Among the patients, 42.2% were women, and the median age was 68 years, with 46.7% of patients aged ≥70 years. The most prevalent disease type was gastrointestinal cancer (75.2%), and 90.9% of the patients had metastatic disease. The median score for the distress thermometer was 4; the vast majority of the patients (98.6%) reported physical problems, and 69.4% presented emotional issues. Younger women demonstrated a significantly greater median distress than other patients (p=0.0018). Almost all symptoms had a higher prevalence on the 0-3 Edmonton Symptom Assessment Scale (ESAS) score, except for fatigue. About 43.8% of the patients received systemic anticancer treatment (SAT) in the last 60 days of life, 15.0% of whom received SAT in the last month and 3.1% in the last 2 weeks. For some symptoms, women frequently had more ESAS >3. Pain and nausea were significantly less reported by older patients compared with younger adults. Men had a lower risk of having MUST score ≥ 2 (p=0.0311). Men and older patients showed a lower prognosis awareness (p=0.0011 and p=0.0049, respectively). Older patients received less SAT within the last 30 days of life (p=0.0006) and had death risk decreased by 20.0%. CONCLUSION Our study identified two subgroups of patients with advanced cancer who require special attention and support due to important symptoms' burden detected by Patient Reported Outcome Measures tests: women and younger adults. These categories of patients require special attention and should be provided early access at SCOC. The role of an oncologist remains crucial to intercept all patients in need of early palliative care and balancing trade-offs of anticancer treatment in advanced metastatic disease.
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Affiliation(s)
- Antonella Galiano
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Stefania Schiavon
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mariateresa Nardi
- Clinical Nutrition Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Ardi Pambuku
- Pain Therapy and Palliative Care Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Rosalba Martino
- Hospital Psychology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maital Bolshinsky
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Sabina Murgioni
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Rossana Intini
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Caterina Soldà
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Dario Marino
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Daniel
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara De Toni
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Chiara Pittarello
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Benedetta Chiusole
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessandra Anna Prete
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Davide Bimbatti
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Floriana Nappo
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Francesca Bergamo
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Antonella Brunello
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Sara Lonardi
- Department of Oncology, Oncology Unit 3, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Iglesias-Santamaría A. Evaluating aggressiveness of end-of-life care in patients with advanced cancer: A retrospective single-center analysis. J Oncol Pharm Pract 2022:10781552221117751. [PMID: 35938188 DOI: 10.1177/10781552221117751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Overuse of anti-cancer therapy near end of life is an important quality-of-care issue. An aggressive approach to treatment can have negative effects on the quality of life and cost of hospital-based resources. The objective of this study was to measure indicators of potential aggressiveness of end-of-life care in a cohort of adult patients with advanced solid tumor. The secondary objective was to analyze the association between clinicopathological variables and indicators of aggressiveness. METHODS Retrospective data analysis was performed on adult patients with solid tumors who received palliative chemotherapy for advanced cancer and died in our hospital between 2017 and 2019. Indicators of aggressiveness of end of life care included chemotherapy use in the last days of life, emergency room visits and hospitalizations (including intensive care unit admissions) in this period, and referral to a palliative care unit before death. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy near end of life. RESULTS Of the 571 patients included, 128 (22.4%) received chemotherapy within the last 2 weeks of life and 102 (17.8%) start a new chemotherapy regimen 30 days before death. During the last month of life, 168 patients (32.9%) visited emergency room more than once and 117 (20.5%) were hospitalized more than once. A total of 294 patients (51.5%) died in the acute care unit and 285 (49.9%) were referred to the palliative care unit. 24 of them (8.4%) died within 72h after referral. CONCLUSIONS The percentage of patients receiving chemotherapy near the end of life as well as the rate of emergency room visits and hospitalizations during this period are much higher than the value of the quality standard established in the literature. According to these indicators, cancer patient care at end of life can be considered overly aggressive. Optimization of palliative care at end of life is necessary.
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Leng A, Maitland E, Wang S, Nicholas S, Lan K, Wang J. Preferences for End-of-Life Care Among Patients With Terminal Cancer in China. JAMA Netw Open 2022; 5:e228788. [PMID: 35467732 PMCID: PMC9039770 DOI: 10.1001/jamanetworkopen.2022.8788] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Importance In China, little is known about end-of-life (EOL) care preferences of patients with terminal cancer. Understanding these patients' treatment preferences is needed to improve patient-centered health care, better inform surrogates and medical staff about patient preferences, and enhance the quality of EOL care. Objective To examine preferences for EOL care among patients with terminal cancer in China. Design, Setting, and Participants In this survey study, patients older than 50 years who had terminal cancer were randomly selected from medical records at a single hospital in China. Data on patients' EOL care preferences were collected by discrete choice experiment (DCE) from August to November 2018 and were analyzed from October 2020 to March 2021. Main Outcomes and Measures The main outcome was patient preferences in EOL care, derived using a mixed logit model. Each DCE scenario described 6 attributes: hospitalization days, life extension, quality of life, adverse treatment events, place-of-death preference, and out-of-pocket costs. The marginal willingness to pay (WTP) in US dollars was estimated from regression coefficients. Results Of 188 patients selected for the survey, 183 participated (97.3%). Among the respondents, the mean [SD] age was 61 [8.4] years, and 128 (69.8%) were male. Patients' preferences for moderate increase in survival time, better quality of life, death at home, and lower out-of-pocket costs were significantly associated with their choices between treatment models. Extending life by 10 months (vs 4 months: β, 1.63; 95% CI, 0.81-2.44) and a better quality of life (very good vs poor: β, 1.79; 95% CI, 0.96-2.62) were the most important attributes to patients. The uptake rate for a treatment scenario increased by 61.6% when the quality of life improved from poor to very good, and when life extension increased from 4 months to 10, the uptake rate increased by 57.2%. The uptake increased by 12.5% when the place of death changed from hospital to home. However, it decreased by 31.4% when the costs increased to $21 174. The study found a WTP of $38 854 (95% CI, $19 468-$95 096) to improve quality of life from a poor to a very good level, substantially higher than the WTP for a life extension of 6 months ($35 308; 95% CI, $17 745-$80 279) or 1 year ($27 572; 95% CI, $16 389-$58 027) compared with the baseline scenario of a 4-month extension. Patients were willing to pay $8860 (95% CI, $621-$26 474) to die at home rather than in a hospital. Conclusions and Relevance The findings suggest that in addition to extending life moderately for patients with terminal cancer, improving quality of life during EOL care and supporting home deaths may deserve greater attention. The findings also suggest that physicians and surrogates should ask about patients' care preferences and better inform them of their choices to improve EOL care outcomes.
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Affiliation(s)
- Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao, China
- Center for Health Preferences Research, Shandong University, Jinan, China
| | | | - Siyuan Wang
- Faculty of Business and Economics, University of Melbourne, North Melbourne, Victoria, Australia
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, New South Wales, Australia
- Newcastle Business School, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kuixu Lan
- Publicity Department, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
- Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China
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Woldie I, Elfiki T, Kulkarni S, Springer C, McArthur E, Freeman N. Chemotherapy during the last 30 days of life and the role of palliative care referral, a single center experience. Palliat Care 2022; 21:20. [PMID: 35125092 PMCID: PMC8819957 DOI: 10.1186/s12904-022-00910-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 01/19/2022] [Indexed: 12/27/2022] Open
Abstract
Background Chemotherapy use closer to the end of life is a marker of poor-quality care. There are now multiple studies and local reviews addressing this issue. Understanding the practice locally will give valuable insight and opportunity for improvement. Methods The study is a retrospective chart review of patients on chemotherapy at the Windsor Regional Cancer Center who died between April 1st, 2016 to December 31st, 2018. Information on demographics, type of cancer, type, intent and route of chemotherapy, line of chemotherapy, referral to hospice and palliative care services was collected. Results A total of 681 patients on chemotherapy died between April 1st, 2016 to Dec 13th, 2018. Of these, 119 (17.4 %) died within 30 days following chemotherapy. Chemotherapy was parenteral (Intravenous and Subcutaneous) for the majority (75.2%) of the patients. Most (66.4%) of the patients died of disease progression. Intent for chemotherapy was palliative in 85% of patients, adjuvant/neoadjuvant in 6.6% and curative in 8.4% of the patients. Chemotherapy was 1st, 2nd, 3rd line or more in 67.4%, 21.3% and 11.3% of the patients respectively. The type of chemotherapy was conventional in 74.3% of patients and targeted/immunotherapy in 25.7% of patients. Of the variables studied, lack of palliative referral and having lung cancer or melanoma were significantly associated with higher risk of getting chemotherapy within the last 30 days of life. The odds of getting chemotherapy within the last 30 days of life was 0.35, 95% CI (0.24-0.53), P <0.001 for those who were referred to palliative care. On the other hand, the odds of getting chemotherapy were 4.18, 95% CI (1.17-13.71), P = 0.037 and 2.21, 95% CI (1.24-4.01), P = 0.037 for those with melanoma and lung cancer respectively. In addition, those with early referral to palliative care (90 days or more prior to death) were least likely to receive chemotherapy within the last 30 days of life. Conclusion Administration of chemotherapy within the last 30 days of life could cause unnecessary suffering to patients and cost to society. Early referral to palliative care was significantly associated with reduced risk of getting chemotherapy within the last 30 days of life in this study. Prospective study is recommended to further investigate the role of early palliative referral on use of chemotherapy during the last 30 days of life.
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Mallett V, Linehan A, Burke O, Healy L, Picardo S, Kelly CM, McCaffrey J, Carney D, McDermott R, Walshe J, Kelleher F, Higgins S, Ryan K, Higgins MJ. A Multicenter Retrospective Review of Systemic Anti-Cancer Treatment and Palliative Care Provided to Solid Tumor Oncology Patients in the 12 Weeks Preceding Death in Ireland. Am J Hosp Palliat Care 2021; 38:1404-1408. [DOI: 10.1177/1049909120985234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Systemic anti-cancer treatment (SACT) can improve symptoms and survival in patients with incurable cancer but there may be harmful consequences. Information regarding the use of SACT at the end-of-life and its impact on patients has not been described in Ireland. Aims: The study aimed to quantify and describe the use of SACT at end-of-life. The primary outcome of interest was the number of patients who received treatment in the last 12, 4 and 2 weeks of life. Secondary outcomes included the frequency of admissions and procedures, location of death, and timing of specialist palliative care (SPC) referral. Methods: Retrospective review. Fisher exact testing was used for analyses. Patients were included if they died between January 2015 and July 2017 and received at least 1 dose of treatment for a solid tumor malignancy. Results: Five hundred and eighty two patients were included. Three hundred and thirty eight (58%), 128 (22%) and 36 (6%) received treatment in the last 12, 4 and 2 weeks of life respectively. Patients who received chemotherapy in the last 12 weeks of life were more likely to be admitted to hospital, undergo a procedure, and die in hospital than those who did not (P < 0.001 for all). Median time of SPC referral before death was shorter in those patients who received chemotherapy than those who did not (61 v129 days, p = 0.0001). Conclusion: Patients who received chemotherapy had a higher likelihood of hospital admission, invasive procedure, and in-hospital death. They were less likely to have been referred early to SPC services.
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Affiliation(s)
| | | | - Orla Burke
- St Francis Hospice, Raheny, Dublin, Ireland
| | | | | | | | | | - Des Carney
- St Francis Hospice, Raheny, Dublin, Ireland
| | | | | | | | | | - Karen Ryan
- St Francis Hospice, Raheny, Dublin, Ireland
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