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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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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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Mohammed AA, Al-Zahrani O, Elsayed FM, Elshentenawy A. Prediction of Survival Outcome Using Chuang's Prognostic Scale in Metastatic Breast Cancer. Indian J Palliat Care 2021; 27:43-46. [PMID: 34035616 PMCID: PMC8121226 DOI: 10.4103/ijpc.ijpc_97_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
Background: For physicians and patients, survival estimation is vital for the treatment plan, especially with frequent use of new therapeutic agents in metastatic breast cancer (MBC). The Chuang's Prognostic Scale (CPS) is a validated prognostic score that may be useful in the avoidance of unnecessary palliative systemic treatment. Aim: The present study aimed to evaluate the CPS in survival prediction in patients with MBC after at least two lines of palliative systemic chemotherapy protocols (PSCPs). Methods: CPS was prospectively measured in 221 patients with MBC. The total score ranged from 0 to 8.5; the lower score refers to a good prognosis. The survival assessment was made by the Kaplan–Meier curve and the survival difference among the groups was estimated by log-rank test. Results: Using the cutoff value of CPS 5.7, the patients were classified into two groups: Group A had score ≤5.7 (174 patients, 78.7%) and Group B had CPS score >5.7 (47 patients, 21.3%). About 86.2% of the patients in Group A survived >3 months (median survival was 165 days, 95% confidence interval [CI]: 77–261) compared with 21.3% of patients survived in Group B (median survival was 81 days, 95% CI: 55–123) (P = 0.00). The sensitivity, specificity, positive predictive value, and negative predictive value were 97.6% (95% CI: 87.4–99.9), 98.3% (95% CI: 95.2–99.7), 93.2% (95% CI: 81.6–97.7), and 99.4% (95% CI: 96.2–99.9), respectively, for the 3-month mortality prediction. Conclusion: CPS could be helpful in estimating the survival outcome in patients with MBC who received at least two PSCPs.
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Affiliation(s)
- Amrallah A Mohammed
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Oncology Center, King Salman Armed Forces Hospital, Tabuk, KSA
| | - Omar Al-Zahrani
- Oncology Center, King Salman Armed Forces Hospital, Tabuk, KSA
| | - Fifi Mostafa Elsayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Cairo, Egypt
| | - Ayman Elshentenawy
- Kasr EL Einy Center of Clinical Oncology and Nuclear Medicine (NEMROCK), Cairo University, Cairo, Egypt
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Mohammed AA, Al-Zahrani O, Salem RA, Elsayed FM. Aggressive Care at the End of Life; Where Are We? Indian J Palliat Care 2019; 25:539-543. [PMID: 31673209 PMCID: PMC6812417 DOI: 10.4103/ijpc.ijpc_59_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Although, efforts to encourage palliative care only for terminal patients, aggressive end-of-life care (EOL) care still common for those probably to die shortly. AIM Multicenter experiences to investigate where did we stand in this era? PATIENTS AND METHODS A retrospective study included patients with advanced solid tumors. The presence of one or more of the following indicators in the last month of life (LM) referred to aggressive EOL care: emergency department (ED) visits ≥ twice, admission to the hospital through ED, death in critical care units (CCUs), and palliative chemotherapy (PC) at the past 2 weeks before death. RESULTS A total of 435 patients, 51.5% were men with a median age of 62 years (range: 17-108), were included in the study. Most of the patients (89.2%) belonged to Group II; they had attended ED at least twice (60%), approximately 53% admitted to the hospital through ED, 31% received PC-LM with 41% of them had at the past 2 weeks before death, 13% died in the CCUs, and more than half of them (53%) survived <2 weeks. Kaplan-Meier estimator revealed that median survival was 30 days in Group I versus 13 days in Group II (odds ratio: 1.63; 95% confidence interval: 1.20-2.21; P = 0.002). The median survival was statistically significantly associated with PC-LM ≥14 days and the admission mode. There was no statistically significant association with age, sex, and primary cancer sites. CONCLUSION The majority of our patients continue with anticancer treatments they possibly do not need and associated with poor survival.
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Affiliation(s)
- Amrallah A Mohammed
- Department of Medical Oncology, Faculty of Medicine, Zagazig University, Egypt
- Oncology Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Omar Al-Zahrani
- Oncology Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Reham A Salem
- Department of Clinical Oncology, Zagazig University, Egypt
- Department of Clinical Oncology, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Fifi Mostafa Elsayed
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Egypt
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Abdel-Razeq H, Shamieh O, Abu-Nasser M, Nassar M, Samhouri Y, Abu-Qayas B, Asfour J, Jarrah J, Abdelrahman Z, Ameen Z, Al-Hawamdeh A, Alomari M, Al-Tabba' A, Al-Rimawi D, Hui D. Intensity of Cancer Care Near the End of Life at a Tertiary Care Cancer Center in Jordan. J Pain Symptom Manage 2019; 57:1106-1113. [PMID: 30802634 DOI: 10.1016/j.jpainsymman.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT Chemotherapy use in the last month of life is an indicator of poor quality of end-of-life care. OBJECTIVES We assessed the frequency of chemotherapy use at the end of life at our comprehensive cancer center in Jordan and identified the factors associated with chemotherapy use. METHODS We conducted a retrospective chart review to examine the use of chemotherapy in the last 30 days and 14 days of life in consecutive adult patients with cancer seen at King Hussein Cancer Center (KHCC) who died between January 1, 2010, and December 31, 2012. We collected data on patient and disease characteristics, palliative care referral, and end-of-life care outcome indicators. RESULTS Among the 1714 decedents, 310 (18.1%) had chemotherapy use in the last 30 days and 142 (8.3%) in the last 14 days of life. Over half (910; 53.1%) had a palliative care referral. Chemotherapy use in the last 30 and 14 days of life were associated with younger age (odds ratio [OR] 0.99/yr, P = 0.01, and OR 0.99/yr, P = 0.01, respectively) and hematological malignances (OR 1.98, P < 0.001, and OR 2.85, P < 0.001, respectively). Palliative care referral was significantly associated with decreased use of chemotherapy in the last 30 (OR 0.30, P < 0.001) and 14 (OR 0.15, P < 0.001) days of life. CONCLUSIONS A sizable minority of patients with cancer at KHCC received chemotherapy at the end of life. Younger patients and those with hematological malignancies were more likely to receive chemotherapy, whereas those referred to palliative care were significantly less likely to receive chemotherapy at the end of life.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Zaid Ameen
- King Hussein Cancer Center, Amman, Jordan
| | | | | | | | | | - David Hui
- MD Anderson Cancer Center, Houston, Texas, USA
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Sinha S, Matharu JK, Jacob J, Palat G, Brun E, Wiebe T, Segerlantz M. Cancer Treatment and End-of-Life Care. J Palliat Med 2018; 21:1100-1106. [DOI: 10.1089/jpm.2017.0695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sudha Sinha
- Medical Oncology, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, India
| | | | - Jean Jacob
- Two Worlds Cancer Collaboration-INCTR Canada, Vancouver, British Columbia, Canada
- Pain and Palliative Medicine Department, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, India
| | - Gayatri Palat
- Pain and Palliative Medicine Department, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, India
- Palliative Access (PAX) Program, India, Two Worlds Cancer Collaboration-INCTR Canada, Vancouver, British Columbia, Canada
| | - Eva Brun
- Department of Clinical Sciences Lund, Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, Paediatrics, Skane University Hospital, Lund University, Lund, Sweden
| | - Mikael Segerlantz
- Department of Clinical Sciences Lund, Faculty of Medicine, Institute for Palliative Care, Lund University, Lund, Sweden
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Paque K, Elseviers M, Vander Stichele R, Pardon K, Hjermstad MJ, Kaasa S, Dilles T, De Laat M, Van Belle S, Christiaens T, Deliens L. Changes in medication use in a cohort of patients with advanced cancer: The international multicentre prospective European Palliative Care Cancer Symptom study. Palliat Med 2018; 32:775-785. [PMID: 29243546 DOI: 10.1177/0269216317746843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Information on medication use in the last months of life is limited. AIM To describe which medications are prescribed and deprescribed in advanced cancer patients receiving palliative care in relation to time before death and to explore associations with demographic variables. DESIGN Prospective study, using case report forms for monthly data collection. Medication included cancer treatment and 19 therapeutic groups, grouped into four categories for: (1) cancer therapy, (2) specific cancer-related symptom relief, (3) other symptom relief and (4) long-term prevention. Data were analysed retrospectively using death as the index date. We compared medication use at 5, 4, 3, 2 and 1 month(s) before death by constructing five cross-sectional subsamples with medication use during that month. Paired analyses were done on a subsample of patients with at least two assessments before death. SETTING/PARTICIPANTS We studied the medication use of 720 patients (mean age 67, 56% male) in 30 cancer centres representing 12 countries. RESULTS From 5 to 1 month(s) before death, cancer therapy decreased (55%-24%), most medications for symptom relief increased, for example, opioids (62%-81%) and sedatives (35%-46%), but medication for long-term prevention decreased (38%-27%). The prevalence of chemotherapy was 15.5% in the last month of life, with 9% of new courses started in the last 2 months. With higher age, chemotherapy and opioid use decreased. CONCLUSION Medications for symptom relief increased in almost all medication groups. Deprescribing was found in heart medication/anti-hypertensives and cancer therapy, although use of the latter remained relatively high.
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Affiliation(s)
- Kristel Paque
- 1 Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium.,2 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Monique Elseviers
- 1 Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Robert Vander Stichele
- 1 Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Koen Pardon
- 2 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Marianne J Hjermstad
- 3 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,4 Regional Advisory Unit for Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- 3 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,5 Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tinne Dilles
- 6 Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Martine De Laat
- 7 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Simon Van Belle
- 2 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,7 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Thierry Christiaens
- 1 Heymans Institute of Pharmacology, Clinical Pharmacology Research Unit, Ghent University, Ghent, Belgium
| | - Luc Deliens
- 2 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,7 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Tang CC, Draucker C, Tejani M, Von Ah D. Symptom experiences in patients with advanced pancreatic cancer as reported during healthcare encounters. Eur J Cancer Care (Engl) 2018; 27:e12838. [DOI: 10.1111/ecc.12838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 01/09/2023]
Affiliation(s)
- C.-C. Tang
- National Taiwan University; Taipei Taiwan
| | - C. Draucker
- Angela Barron McBride Endowed Professorship in Mental Health Nursing; Indiana University School of Nursing; Indianapolis IN USA
| | - M. Tejani
- University of Rochester Medical Center; Rochester NY USA
| | - D. Von Ah
- Department of Community & Health Systems; Indiana University School of Nursing; Indianapolis IN USA
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Martoni AA, Melotti B, Degli Esposti C, Mutri V, Lelli G, Ansaloni S, Piva E, Strocchi E, Pannuti F. Impact of intervention aimed at improving the integration of oncology units and local palliative care services: results of the multicentre prospective sequential MIRTO study. ESMO Open 2017; 2:e000116. [PMID: 28761725 PMCID: PMC5519798 DOI: 10.1136/esmoopen-2016-000116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/08/2016] [Accepted: 12/17/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chemotherapy (CT) in patients with advanced cancer (ACP) near the end of life is an increasing practice of oncology units. A closer integration with palliative care (PC) services could reduce the use of potentially harmful CT. This prospective study is aimed at assessing whether a more integrated care model could reduce CT use near the end of life and increase local PC service utilisation. METHODS The study enrolled sequentially two cohorts of ACP with an estimated life expectancy of ≤6 months. In the first cohort, the usual oncologist's practice to prescribe CT and to activate local PC services were recorded. In cohort 2, the oncologist's decision was taken after an in-hospital consultation with the local PC teams. After patient death, a follow-back survey was carried out. RESULTS The two cohorts included 109 and 125 evaluable patients, respectively. The oncologist's decision to prescribe CT occurred in 51.4% and 60%, respectively: the percentages of patients receiving the final CT administration in the last 30 days of life did not differ in the two cohorts (33.9% and 29.3%, respectively,p=0.83). Conversely, an increase in home PC service utilisation (from 56.9% to 82.4%, p=0.00), at home deaths (from 40.4% to 56.8%, p=0.01) and in-hospice deaths (from 8.3% to 19.2%, p=0.00) occurred in cohort 2. CONCLUSION The implementation of an initial in-hospital consultation of oncologists and experienced home PC teams has not reduced the use of CT near the end of life but increased PC service utilisation and reduced in-hospital deaths.
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Affiliation(s)
- Andrea A Martoni
- Medical Oncology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Barbara Melotti
- Medical Oncology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | | | - Vita Mutri
- Medical Oncology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Giorgio Lelli
- Clinical Oncology, University Hospital, Ferrara, Italy
| | - Silvia Ansaloni
- Medical Oncology Unit, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Erico Piva
- Clinical Oncology, University Hospital, Ferrara, Italy
| | - Elena Strocchi
- Industrial Chemistry Institute, University of Bologna, Bologna, Italy
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Sheng J, Zhang YX, He XB, Fang WF, Yang YP, Lin GN, Wu X, Li N, Zhang J, Zhai LZ, Zhao YY, Huang Y, Zhou NN, Zhao HY, Zhang L. Chemotherapy Near the End of Life for Chinese Patients with Solid Malignancies. Oncologist 2016; 22:53-60. [PMID: 27789776 DOI: 10.1634/theoncologist.2016-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION There are increasing concerns about the negative impacts of chemotherapy near the end of life (EOL). There is discrepancy among different countries about its use, and little is known about the real-world situation in China. PATIENTS AND METHODS This retrospective study was conducted at six representative hospitals across China. Adult decedents with a record of advanced solid cancer and palliative chemotherapy were consecutively screened from 2010 through 2014. The prevalence of EOL chemotherapy within the last 1 month of life was set as the primary outcome. The correlations among EOL chemotherapy, clinicopathological features, and overall survival (OS) were investigated. RESULTS A total of 3,350 decedents who had had cancer were consecutively included; 2,098 (62.6%) were male and the median age was 56 years (range, 20-88). There were 177 (5.3%), 387 (11.6%), and 837 (25.0%) patients who received EOL chemotherapy within the last 2 weeks, 1 month, and 2 months of life, respectively. We identified inferior OS (median OS, 7.1 vs. 14.2 months; hazard ratio, 1.37; 95% confidence interval [CI], 1.23-1.53; p < .001), more intensive treatments (e.g., admitted to intensive care unit [ICU] in the last month of life, received cardiopulmonary resuscitation and invasive ventilation support), and hospital death (odds ratio, 1.53; 95% CI, 1.14-2.06; p = .005) among patients who received continued chemotherapy within the last month compared with those who did not. However, subgroup analyses indicated that receiving oral agents correlated with fewer ICU admissions and lower rates of in-hospital death. CONCLUSION This study showed that EOL chemotherapy is commonly used in China. Intravenous chemotherapy at the EOL significantly correlated with poor outcomes and the role of oral anticancer agents warrants further investigation. The Oncologist 2017;22:53-60Implications for Practice: The role of chemotherapy toward the end of life (EOL) in patients with solid cancers is debatable. This article is believed to be the first to report the current prevalence of EOL chemotherapy in China. This study found that, compared with oral anticancer agents, intravenous chemotherapy at the EOL was significantly associated with poor outcomes. Therefore, the role of oral anticancer agents at the EOL stage deserves further investigation.
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Affiliation(s)
- Jin Sheng
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ya-Xiong Zhang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Xiao-Bo He
- Department of Radiotherapy, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Wen-Feng Fang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yun-Peng Yang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Gui-Nan Lin
- Department of Medical Oncology, Zhongshan City People's Hospital, Zhongshan, People's Republic of China
| | - Xuan Wu
- Department of Medical Oncology, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Ning Li
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Jing Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Lin-Zhu Zhai
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Yuan-Yuan Zhao
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yan Huang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ning-Ning Zhou
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Hong-Yun Zhao
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Li Zhang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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Assi T, El Rassy E, Tabchi S, Ibrahim T, Moussa T, Chebib R, El Karak F, Farhat F, Chahine G, Nasr F, Ghosn M, Kattan J. Treatment of cancer patients in their last month of life: aimless chemotherapy. Support Care Cancer 2015; 24:1603-8. [PMID: 26391890 DOI: 10.1007/s00520-015-2959-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/14/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE The use of chemotherapy in the last month of life (CLML) of cancer patients is considered an aggressive approach to be avoided. We examined the practice of CLML in Lebanese cancer patients, and we investigated patient and tumor characteristics that justify this practice. To our knowledge, this is the first study describing CLML of Middle Eastern patients with advanced cancer. METHODS We conducted this study at Hotel-Dieu de France University Hospital (HDF), Lebanon. Cases eligible for this study were all individuals diagnosed with cancer who died at HDF between the 1st of January and the 31st of December 2014. Demographic and clinical characteristics of the patients were obtained from the hospital registration records. Data concerning the management plan, primary malignancy and stage, chemo-sensitivity, line, type, and timing of chemotherapy in the last month of life were also obtained. RESULTS Among the 130 cancer patients who were enrolled, CLML was administered to a total of 55 patients (42.3 %), of whom 26 patients (50 %) received more than one cytotoxic drug. Oral drug was only given to 9 patients (16.4 %). Interestingly, CLML increased the risk of death in the last month of life (p = 0.02), yet progression of disease constituted the major cause of death in this subgroup (54.6 %). The only variable to have statistical significant correlation with CLML was performance status (p = 0.03). The type of tumor and recent diagnosis of less than 2 months were also correlated to CLML (p = 0.03 and 0.024, respectively). CONCLUSION The high percentage of patients receiving CLML underlines the difficulty of end-of-life discussions in patients from Middle Eastern societies. This is true in the context of a country with little availability of palliative care resources, where health policies should be more focused on incorporating palliative medicine in all medical strategies.
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Affiliation(s)
- Tarek Assi
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Elie El Rassy
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Samer Tabchi
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Toni Ibrahim
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tania Moussa
- Department of Radiology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ralph Chebib
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi El Karak
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi Farhat
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Chahine
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi Nasr
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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