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Roberts HN, Solomon B, Harden S, Lingaratnam S, Alexander M. Utility of 30-Day Mortality Following Systemic Anti-Cancer Treatment as a Quality Indicator in Advanced Lung Cancer. Clin Lung Cancer 2024; 25:e211-e220.e1. [PMID: 38772809 DOI: 10.1016/j.cllc.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND 30-day mortality after systemic anti-cancer therapy (SACT) has been suggested as a quality indicator primarily for measuring use of chemotherapy towards the end of life. Utility across different cancer types is unclear, especially when using immunotherapy and targeted therapies. METHODS This retrospective study included patients with a diagnosis of lung cancer who received palliative-intent SACT at an Australian metropolitan cancer center between 2015 and 2022. Using a prospectively maintained lung cancer database, patient, disease, and treatment characteristics were evaluated against annual 30-day mortality rates following SACT. RESULTS 1072 patients were identified. Annual 30-day mortality rate after palliative-intent SACT for lung cancer ranged between 9% and 15%, with significant variance between treatment types. Calculated rates of 30-day mortality are higher if longer reporting time periods are used. Patients who died within 30 days of SACT were more likely to have received targeted therapies or immunotherapy as their final line of treatment, have a poorer performance status at diagnosis, and have received multiple lines of treatment. CONCLUSIONS Our data support differential interpretation of 30-day mortality for quality assurance, especially with regard to lung cancer. Consistency in population and reporting time periods, and accounting for treatment type is crucial if 30-day mortality is to be utilized as cancer care performance quality indicator. Relevance to quality care is questionable in the lung cancer setting.
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Affiliation(s)
| | - Benjamin Solomon
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Susan Harden
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Senthil Lingaratnam
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia.
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2
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Singh J, Stensvold A, Turzer M, Grov EK. Anticancer therapy at end-of-life: A retrospective cohort study. Acta Oncol 2024; 63:313-321. [PMID: 38716486 PMCID: PMC11332458 DOI: 10.2340/1651-226x.2024.22139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/29/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND A significant proportion of patients with incurable cancer receive systemic anticancer therapy (SACT) within their last 30 days of life (DOL). The treatment has questionable benefit, nevertheless is considered a quality indicator of end-of-life (EOL) care. This retrospective cohort study aims to investigate the rates and potential predictors of SACT and factors associated with SACT within the last 30 DOL. The study also evaluates the scope of Eastern Cooperative Oncology Group (ECOG) performance status and the modified Glasgow prognostic score (mGPS) as decision-making tools for oncologists. PATIENTS AND MATERIAL This review of medical records included 383 patients with non-curable cancer who died between July 2018 and December 2019. Descriptive statistics with Chi-squared tests and regression analysis were used to identify factors associated with SACT within the last 30 DOL. RESULTS Fifty-seven (15%) patients received SACT within the last 30 DOL. SACT within 30 last DOL was associated with shorter time from diagnosis until death (median 234 days vs. 482, p = 0.008) and ECOG score < 3 30 days prior to death (p = 0.001). Patients receiving SACT during the last 30 DOL were more likely to be hospitalised and die in hospital. ECOG and mGPS score were stated at start last line of treatment only in 139 (51%) and 135 (49%) respectively. INTERPRETATION Those with short time since diagnosis tended to receive SACT more frequently the last 30 DOL. The use of mGPS as a decision-making tool is modest, and there is lack in documentation of performance status.
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Affiliation(s)
- Johnny Singh
- Østfold Hospital Trust, Department of Oncology, Graalum, Norway; Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo, Norway.
| | | | - Martin Turzer
- Østfold Hospital Trust, Department of Oncology, Graalum, Norway
| | - Ellen Karine Grov
- Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo, Norway
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3
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Golob N, Oblak T, Čavka L, Kušar M, Šeruga B. Aggressive anticancer treatment in the last 2 weeks of life. ESMO Open 2024; 9:102937. [PMID: 38471241 PMCID: PMC10944113 DOI: 10.1016/j.esmoop.2024.102937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND There is a concern that terminally ill cancer patients may be aggressively treated due to the rapidly growing possibilities of anticancer treatment. The aim of this study was to evaluate the use of anticancer treatment at the end of life (EoL). MATERIALS AND METHODS This retrospective study included adult patients with advanced solid cancers who were treated at the Institute of Oncology Ljubljana and died of cancer between January 2015 and December 2019. A multiple logistic regression model was used to assess an association between the aggressiveness of anticancer treatment (i.e. systemic therapy, radiotherapy and surgery) in the last 2 weeks of life and year of death, age at death, sex, prognosis of cancer and enrolment into the specialist palliative care (SPC). RESULTS We included 1736 patients in our analysis. Overall, 13.7% of patients were enrolled into the SPC and 14.4% received anticancer treatment in the last 2 weeks of life. The odds of receiving anticancer treatment significantly increased over time [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.04-1.27]. There was an increased use of novel systemic therapy (e.g. small-molecule targeted therapy and immunotherapy) at the EoL. Older patients had significantly lower odds to receive anticancer treatment in the last 2 weeks of life as compared to younger patients (OR 0.96, 95% CI 0.95-0.98). As compared to patients receiving only a standard oncology care, those also enrolled into the SPC had significantly lower odds for anticancer treatment in the last 2 weeks of life (OR 0.22, 95% CI 0.12-0.43). CONCLUSIONS Terminally ill cancer patients have increased odds for receiving anticancer treatment, especially novel systemic therapies, in the last 2 weeks of life. Younger patients and those not enrolled into the SPC are at particular risk for anticancer treatment at the EoL.
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Affiliation(s)
- N Golob
- Faculty of Medicine, University of Ljubljana, Ljubljana; Department of Acute Palliative Care, Institute of Oncology Ljubljana, Ljubljana
| | - T Oblak
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana
| | - L Čavka
- Faculty of Medicine, University of Ljubljana, Ljubljana; Department of Oncology, University Medical Center Maribor, Maribor
| | - M Kušar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - B Šeruga
- Faculty of Medicine, University of Ljubljana, Ljubljana; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
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4
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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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5
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Chung MC, Tsai PY, Chen CM, Yang CK, Chang HH. Meridian energy analysis may predict the prognosis of patients with advanced cancers receiving palliative care. J Tradit Complement Med 2023. [DOI: 10.1016/j.jtcme.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
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6
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Zimbwa B, Gilbar PJ, Davis MR, Kondalsamy-Chennakesavan S. Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre. J Oncol Pharm Pract 2021:10781552211016086. [PMID: 33990165 DOI: 10.1177/10781552211016086] [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
PURPOSE To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. METHOD All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. RESULTS Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). CONCLUSION The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.
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Affiliation(s)
| | - Peter J Gilbar
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia.,Rural Clinical School, Faculty of Medicine, The University of Queensland Toowoomba, Toowoomba, Australia
| | - Mark R Davis
- Cancer Care Services, Toowoomba Hospital, Toowoomba, Australia
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Kobayashi H, Tsuchiyama K, Taga M, Tokunaga T, Ito H, Yokoyama O. Impact of self-decision to stop cancer treatment on advanced genitourinary cancer patients. Medicine (Baltimore) 2021; 100:e25397. [PMID: 33832133 PMCID: PMC8036094 DOI: 10.1097/md.0000000000025397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/15/2021] [Indexed: 01/05/2023] Open
Abstract
Decision-making to stop cancer treatment in patients with advanced cancer is stressful, and it significantly influences subsequent end-of-life palliative treatment. However, little is known about the extent to which the patient's self-decisions influenced the prognostic period. This study focused on the patient's self-decision and investigated the impact of the self-decision to stop cancer treatment on their post-cancer treatment survival period and place of death.We retrospectively analyzed 167 cases of advanced genitourinary cancer patients (kidney cancer: 42; bladder cancer: 68; prostate cancer: 57) treated at the University of Fukui Hospital (UFH), who later died because of cancer. Of these, 100 patients decided to stop cancer treatment by themselves (self-decision group), while the families of the remaining 67 patients (family's decision group) decided to stop treatment on their behalf because the patient's decision-making ability was already impaired. Differences in the post-cancer-treatment survival period and place of death between the 2 groups were examined. The association between place of death and survival period was also analyzed.The median survival period after terminating cancer treatment was approximately 6 times longer in the self-decision group (145.5 days in self-decision group vs 23.0 days in family's decision group, P < .001). Proportions for places of death were as follows: among the self-decision group, 42.0% of patients died at UFH, 45.0% at other medical institutions, and 13.0% at home; among the family's decision group, 62.7% died at UFH, 32.8% at other medical institutions, and 4.5% at home. The proportion of patients who died at UFH was significantly higher among the family's decision group (P = .011). The median survival period was significantly shorter for patients who died at UFH (UFH: 30.0 days; other institutions/home: 161.0 days; P < .001).Significantly longer post-cancer-treatment survival period and higher home death rate were observed among patients whose cancer treatment was terminated based on their self-decision. Our results provide clinical evidence, especially in terms of prognostic period and place of death that support the importance of discussing bad news, such as stopping cancer treatment with patients.
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Affiliation(s)
- Hisato Kobayashi
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui
| | - Katsuki Tsuchiyama
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui
- Department of Urology, Ibe Hospital, Fukui
| | - Minekatsu Taga
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui
| | - Takahiro Tokunaga
- Medical Research Support Center, University of Fukui Hospital, Fukui
- Research Promotion Office, Shinseikai Toyama Hospital, Toyama, Japan
| | - Hideaki Ito
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui
| | - Osamu Yokoyama
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, University of Fukui, Fukui
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Tashkandi E, Al-Abdulwahab A, Basulaiman B, Alsharm A, Al-Hajeili M, Alshadadi F, Halawani L, Al-Mansour M, Alquzi B, Barnawi S, Alghamdi M, Abdelaziz N, Azher R. Mortality and morbidity of curative and palliative anticancer treatments during the COVID-19 pandemic: A multicenter population-based retrospective study. Mol Clin Oncol 2021; 14:82. [PMID: 33758663 PMCID: PMC7947946 DOI: 10.3892/mco.2021.2244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/09/2021] [Indexed: 01/08/2023] Open
Abstract
Administration of effective anticancer treatments should continue during pandemics. However, the outcomes of curative and palliative anticancer treatments during the coronavirus disease (COVID-19) pandemic remain unclear. The present retrospective observational study aimed to determine the 30-day mortality and morbidity of curative and palliative anticancer treatments during the COVID-19 pandemic. Between March 1 and June 30, 2020, all adults (n=2,504) with solid and hematological malignancies irrespective of cancer stage and type of anticancer treatments at five large comprehensive cancer centers in Saudi Arabia were included. The 30-day mortality was 5.1% (n=127) for all patients receiving anticancer treatment, 1.8% (n=24) for curative intent, 8.6% (n=103) for palliative intent and 13.4% (n=12) for COVID-19 cases. The 30-day morbidity was 28.2% (n=705) for all patients, 17.9% (n=234) for curative intent, 39.3% (n=470) for palliative intent and 75% (n=77) for COVID-19 cases. The 30-day mortality was significantly increased with male sex [odds ratio (OR), 2.011; 95% confidence interval (CI), 1.141-3.546; P=0.016], body mass index (BMI) <25 (OR, 1.997; 95% CI, 1.292-3.087; P=0.002), hormone therapy (OR, 6.315; 95% CI, 0.074-2.068; P=0.001) and number of cycles (OR, 2.110; 95% CI, 0.830-0.948; P=0.001), but decreased with Eastern Cooperative Oncology Group performance status (ECOG-PS) of 0-1 (OR, 0.157; 95% CI, 0.098-0.256; P=0.001), stage I-II cancer (OR, 0.254; 95% CI, 0.069-0.934; P=0.039) and curative intent (OR, 0.217; 95% CI, 0.106-0.443; P=0.001). Furthermore, the 30-day morbidity significantly increased with age >65 years (OR, 1.420; 95% CI, 1.075-1.877; P=0.014), BMI <25 (OR, 1.484; 95% CI, 1.194-1.845; P=0.001), chemotherapy (OR, 1.397; 95% CI, 1.089-5.438; P=0.032), hormone therapy (OR, 1.527; 95% CI, 0.211-1.322; P=0.038) and immunotherapy (OR, 1.859; 95% CI, 0.648-4.287; P=0.038), but decreased with ECOG-PS of 0-1 (OR, 0.502; 95% CI, 0.399-0.632; P=0.001), breast cancer (OR, 0.569; 95% CI, 0.387-0.836; P=0.004) and curative intent (OR, 0.410; 95% CI, 0.296-0.586; P=0.001). The mortality risk was lowest with curative treatments. Therefore, such treatments should not be delayed. The morbidity risk doubled with palliative treatments and was highest among COVID-19 cases. Mortality appeared to be driven by male sex, BMI <25, hormonal therapy and number of cycles, while morbidity increased with age >65 years, BMI <25, chemotherapy, hormonal therapy and immunotherapy. Therefore, oncologists should select the most effective anticancer treatments based on the aforementioned factors.
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Affiliation(s)
- Emad Tashkandi
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah 21421, Saudi Arabia.,Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Amal Al-Abdulwahab
- Department of Medical Oncology, Oncology Center, King Abdullah Medical City, Makkah 24246, Saudi Arabia
| | - Bassam Basulaiman
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11564, Saudi Arabia
| | - Marwan Al-Hajeili
- Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Faisal Alshadadi
- Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Lamis Halawani
- Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mubarak Al-Mansour
- Department of Medical Oncology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah 21423, Saudi Arabia.,Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia
| | - Bushra Alquzi
- Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia
| | - Samar Barnawi
- Department of Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia
| | - Mohammed Alghamdi
- Department of Medical Oncology, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Nashwa Abdelaziz
- Department of Medical Oncology, College of Medicine, King Saud University, Riyadh 11362, Saudi Arabia
| | - Ruqayya Azher
- Community Medicine Department, Umm Al-Qura University, Makkah 21421, Saudi Arabia
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9
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Tashkandi E, Basulaiman B, Alghareeb W, Hamadi F, Alghamdi A, Albabakri F, Alshabi R, Jaffal M, Albaradie A, Azher R. Thirty-Day Mortality After Curative and Palliative Anti-Cancer Treatment: Data Interpretation and Lessons for Clinical Implementation. Cancer Manag Res 2020; 12:12301-12308. [PMID: 33293858 PMCID: PMC7718861 DOI: 10.2147/cmar.s277924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Despite advancements in cancer therapeutics, mortality and morbidity due to anti-cancer treatments still occur but are not frequently reported. We aimed to report the 30-day mortality and morbidity of all curative and palliative anti-cancer treatments. Patients and Methods Adults with solid and hematological malignancies from two large cancer centers in Saudi Arabia, irrespective of the cancer stage and treatment type, were included in this retrospective observational study. Results Between December 1, 2019 and February 29, 2020, 1694 patients from King Abdullah Medical City in Makkah and King Fahad Medical City in Riyadh were included in the study. Among them, 77.5% were younger than 65 years of age; 72.8% were female; the prevalence of obesity, diabetes, and hypertension was 35%, 34%, and 28%, respectively; and 66.5% of patients had breast and gastrointestinal cancers. Fifty-nine (3.5%) patients died within 30 days of receiving anti-cancer treatment. Of them, 9 (0.3%) were treated with curative intent, and 50 (3%) were treated with palliative intent. Conclusion Our results emphasize the need to address preventable metabolic changes and implement innovative, predictive, preventive, and personalized medicine (PPPM) approaches focusing on patient profiles. Reporting the 30-day outcomes of all anti-cancer treatments will also allow the identification of factors underlying mortality and morbidity and lead to an improvement in oncological outcomes via innovative programs designed to improve clinical decision-making.
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Affiliation(s)
- Emad Tashkandi
- Umm AlQura University, College of Medicine, Makkah, Saudi Arabia.,King Abdullah Medical City, Oncology Center, Makkah, Saudi Arabia
| | - Bassam Basulaiman
- Comprehensive Cancer Center, Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Waleed Alghareeb
- Comprehensive Cancer Center, Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faris Hamadi
- Comprehensive Cancer Center, Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Anas Alghamdi
- Comprehensive Cancer Center, Medical Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faez Albabakri
- King Abdullah Medical City, Oncology Center, Makkah, Saudi Arabia
| | - Redhwan Alshabi
- King Abdullah Medical City, Oncology Center, Makkah, Saudi Arabia
| | - Mohammad Jaffal
- King Abdullah Medical City, Oncology Center, Makkah, Saudi Arabia
| | | | - Ruqayya Azher
- Umm Al-Qura University, Community Medicine Department, Makkah, Saudi Arabia
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10
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García-Martín E, Escudero-Vilaplana V, Fox B, Collado-Borrell R, Marzal-Alfaro B, Sánchez-Isac M, Solano-Garzón ML, González Del Val R, Cano-González JM, Pérez de Lucas N, Bravo-Guillén AI, Valero-Salinas J, González-Haba E, Sanjurjo M, Martín M. Aggressiveness of end-of-life cancer care: what happens in clinical practice? Support Care Cancer 2020; 29:3121-3127. [PMID: 33067765 DOI: 10.1007/s00520-020-05828-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE End-of-life cancer care varies widely, and very few centers evaluate it systematically. Our objective was to assess indicators of the aggressiveness of end-of-life cancer care in clinical practice. METHODS An observational, longitudinal, and retrospective cohort study was conducted at a tertiary hospital. Eligible patients were at least 18 years old, had a solid tumor, were followed up by the Oncology Department, and had died because of cancer or associated complications during 2017. We used the criteria of Earle et al. (J Clin Oncol 21(6):1133-1138, 2003) to assess the aggressiveness of care. Multivariate logistic regression analyses were performed to characterize factors associated with aggressiveness of therapy. RESULTS The study population comprised 684 patients. Eighty-eight patients (12.9%) received anti-cancer treatment during the last 14 days of their lives, and 62 patients (9.1%) started a new treatment line in the last 30 days. During the last month of life, 102 patients (14.9%) visited the ER, 80 patients (11.7%) were hospitalized more than once, and 26 (3.8%) were admitted to the ICU. A total of 326 patients (47.7%) died in the acute care unit. A total of 417 patients (61.0%) were followed by the Palliative Care Unit, and in 54 cases (13.0%), this care started during the last 3 days of life. CONCLUSIONS The use of anti-cancer therapies and health care services in our clinical practice, except for the ICU, did not meet the Earle criteria for high-quality care. Concerning hospice care, more than half of the patients received hospice services before death, although in some cases, this care started close to the time of death.
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Affiliation(s)
- Estela García-Martín
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Bárbara Fox
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Belén Marzal-Alfaro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - María Sánchez-Isac
- Palliative Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Luisa Solano-Garzón
- Palliative Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ricardo González Del Val
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | | | | | - Eva González-Haba
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - María Sanjurjo
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Miguel Martín
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Nguyen M, Ng Ying Kin S, Shum E, Wann A, Tamjid B, Sahu A, Torres J. Anticancer therapy within the last 30 days of life: results of an audit and re-audit cycle from an Australian regional cancer centre. BMC Palliat Care 2020; 19:14. [PMID: 31987038 PMCID: PMC6986019 DOI: 10.1186/s12904-020-0517-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/15/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. METHODS A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to the cancer services meeting and a quality improvement intervention program was instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. RESULTS The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. CONCLUSION This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and a better risk benefit balance.
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Affiliation(s)
| | | | - Evonne Shum
- Goulburn Valley Health, Shepparton, Australia
| | | | | | - Arvind Sahu
- Goulburn Valley Health, Shepparton, Australia
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