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Liu DTF, Misra R, Moore T. Palliative Radiotherapy in Non-small Cell Lung Cancer: Patterns of Use and Predictors of 30-Day Mortality in End-of-Life Care. Cureus 2024; 16:e65238. [PMID: 39184714 PMCID: PMC11343330 DOI: 10.7759/cureus.65238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Lung cancer is the leading cause of cancer-related deaths worldwide, with non-small cell lung cancer (NSCLC) being the most common type. More than half of patients require radiotherapy throughout their treatment. Palliative radiotherapy (PRT) is an important tool for symptom control and quality of life improvement in advanced NSCLC patients. However, the benefits of PRT must be balanced against possible disadvantages, especially in end-of-life (EOL) care. This study aims to describe the profile of PRT-treated deceased NSCLC patients, quantify the proportion of PRT recipients in the last 30 days of life and identify short-term survival prognostic factors in this group. Materials and methods This retrospective analysis was performed at two radiotherapy facilities within the Kent Oncology Centre, UK, for two years, running from January 1, 2022, to January 1, 2024. Data were collected from 857 deceased NSCLC patients who received PRT. Demographics, cancer diagnosis, histology, tumour, node, metastasis (TNM) staging, radiotherapy details, recent treatments, performance status (PS) and comorbidities were analysed. Patients have been stratified as long-term survivors (more than 30 days after PRT initiation, LTS group) along with short-term survivors (STS) (died within 30 days, STS group). Descriptive statistics, chi-squared tests, t-tests and multivariable logistic regression have been used in the data analysis. Results Out of 857 patients, 148 (17.3%) died within 30 days of PRT initiation. PS was considerably worse (p = 0.027), Adult Comorbidity Evaluation 27 (ACE-27) scores were higher (p = 0.018), and metastatic disease was more prevalent (60.1% vs. 47.5%, p = 0.02) in STS group patients. Fewer patients in the STS group completed their treatment compared to the LTS group (63.5% vs. 82.8%, p < 0.001). The STS group also received lower mean radiation dose (17.7 Gy vs. 19.6 Gy, p = 0.022) and fewer fractions (4.4 vs. 5.2, p = 0.019). The most common RT regimen in both cohorts was 20 Gy in five fractions, used in 55.4% of STS and 49.8% of LTS patients, with no significant difference in single fraction RT use between groups (33.1% in STS vs. 36.8% in LTS, p = 0.401). Multivariate logistic regression identified significant predictors of 30-day mortality: poorer PS (adjusted OR: 1.981, 95% CI: 1.33-3.12, p = 0.001), metastatic disease (adjusted OR: 2.02, 95% CI: 1.246-3.571, p = 0.002), incomplete PRT (adjusted OR: 0.337, 95% CI: 0.21-0.514, p < 0.001) and no recent chemotherapy (adjusted OR: 0.542, 95% CI: 0.342-0.941, p = 0.044). Conclusion This study demonstrated that compared with previous reports, a higher proportion of NSCLC patients who received PRT died within 30 days of treatment initiation, and low treatment adherence rates highlight challenges in EOL settings. Identification of poor PS and metastatic disease as predictors of short-term mortality would help inform PRT decision-making. The underutilisation of single-fraction radiotherapy and the link between recent chemotherapy and lower 30-day mortality warrant further study. These results highlight the need for better prognostic tools and more selective use of PRT, including increased consideration of single-fraction radiotherapy, in NSCLC patients approaching end of life and emphasise the importance of balancing benefit against treatment burden in this vulnerable population.
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Huang HW, Liu CY, Tung TH, Liu LN. Effects of hospice-shared care on terminal cancer patients in Taiwan: A hospital-based observational study. Eur J Oncol Nurs 2024; 69:102525. [PMID: 38340644 DOI: 10.1016/j.ejon.2024.102525] [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: 04/18/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess how hospice-shared care (HSC) affected the likelihood of aggressive medical treatments and the life quality among terminal cancer patients. METHODS In the first part, a cohort of 160 late-stage cancer patients who died in non-hospice wards were identified to review their charts in their last 22 days before death. In the second part, a total of 19 late-stage cancer patients with clear consciousness admitted to non-hospice wards were identified to investigate their quality of life for the final 2 weeks before death. RESULTS The utilization rate of HSC was 55.6%. Among these, the rate for late referral to HSC (≤7 days before death) was 43.8% and early referral (>3 months before death) was 5.6%. Compared to the non-HSC group, in the last few weeks of life, the HSC group underwent lower incidence of chemotherapy use (10.1% vs. 39.4%, p < .001), signed do-not-resuscitate orders (0% vs. 21.1%, p < .001), emergency room visits (13.5% vs. 40.8%, p < .001), intensive care unit admission or ventilator use (2.2% vs. 11.3%, p = .019), and endotracheal intubation (2.2% vs. 9.9%, p = .038). However, the quality of life did not appear to have obvious differences between the two groups (p > .05). CONCLUSION In Taiwan, late HSC referral in terminal cancer patients is common. HSC is associated with a reduced likelihood of aggressive medical utilization. However, the effect of HSC in improving patients' quality of life in the last few weeks needs to be further evaluated.
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Affiliation(s)
- Hui-Wen Huang
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
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Hjermstad MJ, Pirnat A, Aass N, Andersen S, Astrup GL, Dajani O, Garresori H, Guldhav KV, Hamre H, Haukland EC, Jordal F, Lundeby T, Løhre ET, Mjåland S, Paulsen Ø, Semb KA, Staff ES, Wester T, Kaasa S. PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life. Palliat Med 2024; 38:229-239. [PMID: 38193250 PMCID: PMC10865754 DOI: 10.1177/02692163231222391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. AIM To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. DESIGN Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used. SETTING A total of 12 Norwegian hospitals (03/2017-02/2021). PARTICIPANTS Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months. RESULTS A total of 616 (93%) patients were included (intervention: 309/control:307); 63% males, median age 69, 77% had gastrointestinal cancers. Median survival time from inclusion was 8 (IQR 3-14) and 7 months (IQR 3-12), and days between anticancer therapy start and death were 204 (90-378) and 168 (69-351) (intervention/control). Overall, 78 patients (13%) received anticancer therapy in the last month (intervention: 33 [11%]/control: 45 [15%]). No differences were found in patient-reported outcomes. CONCLUSION We found no significant differences in the probability of receiving end-of-life anticancer therapy. The intervention did not have the desired effect. It was probably too general and too focussed on communication skills to exert a substantial influence on conventional clinical practice.
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Affiliation(s)
- Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Aleksandra Pirnat
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Aass
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigve Andersen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Guro L Astrup
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Herish Garresori
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Kristin V Guldhav
- Department of Oncology and Palliative Care, Førde Hospital Trust, Førde, Norway
| | - Hanne Hamre
- Department of Oncology, Akershus University Hospital, Akershus, Norway
| | - Ellinor C Haukland
- Department of Oncology and Palliative Care, Nordland Hospital Trust, Nordland, Norway
| | - Frode Jordal
- Department of Clinical Oncology, Østfold Hospital Trust, Østfold, Norway
| | - Tonje Lundeby
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Torbjorn Løhre
- Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Mjåland
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Karin A Semb
- Department of Oncology and Palliative Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - Erik S Staff
- Department of Oncology, Ålesund Hospital Trust, Ålesund, Norway
| | - Torunn Wester
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Stone P, Buckle P, Dolan R, Feliu J, Hui D, Laird BJA, Maltoni M, Moine S, Morita T, Nabal M, Vickerstaff V, White N, Santini D, Ripamonti CI. Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:101195. [PMID: 37087198 PMCID: PMC10242351 DOI: 10.1016/j.esmoop.2023.101195] [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] [Received: 11/30/2022] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 04/24/2023] Open
Abstract
•This ESMO Clinical Practice Guideline provides key recommendations for using prognostic estimates in advanced cancer. •The guideline covers recommendations for patients with cancer and an expected survival of months or less. •An algorithm for use of clinical predictions, prognostic factors and multivariable risk prediction models is presented. •The author group encompasses a multidisciplinary group of experts from different institutions in Europe, USA and Asia. •Recommendations are based on available scientific data and the authors’ collective expert opinion.
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Affiliation(s)
- P Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK; Palliative Care Team, Central and North West London NHS Trust, London, UK
| | | | - R Dolan
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - J Feliu
- Department of Medical Oncology, La Paz University Hospital, IdiPAZ, CIBERONC, Cátedra UAM-AMGEN, Madrid, Spain
| | - D Hui
- Departments of Palliative Care, Rehabilitation and Integrative Medicine, Houston, USA; General Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - B J A Laird
- Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK; St Columba's Hospice Care, Edinburgh, UK
| | - M Maltoni
- Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - S Moine
- Health Education and Practices Laboratory (LEPS EA3412), University Paris Sorbonne Paris Cité, Bobigny, Paris, France
| | - T Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara General Hospital, Shizuoka, Japan
| | - M Nabal
- Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - V Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - N White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - D Santini
- UOC Oncologia Medica Territoriale, La Sapienza University of Rome, Polo Pontino, Rome, Italy
| | - C I Ripamonti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, 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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Tolppanen AM, Lamminmäki A, Länsimies H, Kataja V, Tyynelä-Korhonen K. Trends in end-of-life decisions among patients dying in a university hospital oncology ward after implantation of a palliative outpatient clinic. Acta Oncol 2022; 61:881-887. [PMID: 35467470 DOI: 10.1080/0284186x.2022.2063068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The need for high quality palliative care at end-of-life has been increasingly recognized while regional differences exist in its quality and availability. Basic palliative care is given by oncologists at any stage of the disease, but this does not cover the high need for specialized palliative care. The aim of this study was to assess the trends in end-of-life decisions among patients dying in a university hospital oncology ward before and after the implementation of a palliative outpatient clinic. MATERIAL AND METHODS The study population consists of all patients who died in the Kuopio University Hospital oncology ward between 1.1.2010-31.10.2011 and 1.1.2012-31.12.2018. The palliative outpatient clinic was established and set up in November - December 2011. Data on inpatient stays, cancer treatments, treatment decisions, and some background factors were retrieved from electronic records. RESULTS The study population totaled 644 patients dying in the oncology ward at KUH (57.8% males; 42.2% females). The deaths comprise 17.2% (191/1108) of all cancer deaths in 2010-2011 and 11.1% (461/4049) in 2012-2018 in the KUH catchment area (North-Savo Health Care District). In years 2012-2018, 14.1% of patients treated at KUH oncology clinic visited the palliative outpatient clinic. The percentage of DNR (do-not-resuscitate), palliative care, and end-of-life (EOL) care decisions increased significantly in the later period. The decisions were mainly made during the last week of life. The proportion of patients receiving chemotherapy during the last two weeks of life remained stable. CONCLUSION The proportion of patients receiving DNR, palliative care and EOL care decisions increased after the implementation of the palliative outpatient clinic, but the decisions were still made rather late, mainly during the last days of life.
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Affiliation(s)
- Anna-Maria Tolppanen
- Center of Oncology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Annamarja Lamminmäki
- Center of Oncology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Helena Länsimies
- University of Eastern Finland, Kuopio, Finland
- City of Kuopio, Kuopio, Finland
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Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: a meta-analysis. Radiother Oncol 2022; 168:147-210. [DOI: 10.1016/j.radonc.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
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Nieder C, Dalhaug A, Haukland E. The LabBM score is an excellent survival prediction tool in patients undergoing palliative radiotherapy. Rep Pract Oncol Radiother 2021; 26:740-746. [PMID: 34760308 DOI: 10.5603/rpor.a2021.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background and aim The prognostic assessment of patients referred for palliative radiotherapy can be conducted by site-specific scores. A quick assessment that would cover the whole spectrum could simplify the working day of clinicians who are not specialists for a particular disease site. This study evaluated a promising score, the LabBM (validated for brain metastases), in patients treated for other indications. Materials and methods The LabBM score was calculated in 375 patients by assigning 1 point each for C-reactive protein and lactate dehydrogenase above the upper limit of normal, and 0.5 points each for hemoglobin, platelets and albumin below the lower limit of normal. Uni- and multivariate analyses were performed. Results Median overall survival gradually decreased with increasing point sum (range 25.1-1.1 months). When grouped according to the original three-tiered model, excellent discrimination was found. Patients with 0-1 points had a median survival of 15.7 months. Those with 1.5-2 points had a median survival of 5.8 months. Finally, those with 2.5-3.5 points had a median survival of 3.2 months (all p-values ≤ 0.001). Conclusion The LabBM score, which is derived from inexpensive blood tests and easy to use, stratified patients into three very distinct prognostic groups and deserves further validation.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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Lapeyre-Prost A, Perkins G, Vallee M, Pozet A, Tougeron D, Maillet M, Locher C, Dreanic J, Legoux JL, Lièvre A, Lecaille C, Sabate JM, Mary F, Bonnetain F, Jaulmes-Bouillot H, Behal F, Landi B, Taieb J. Chemotherapy use in end-of-life digestive cancer patients: a retrospective AGEO observational study. Clin Res Hepatol Gastroenterol 2021; 45:101709. [PMID: 33930588 DOI: 10.1016/j.clinre.2021.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/05/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of chemotherapy (CT) near the end-of-life (EOL) is an important issue in oncology since it could degrade quality of life. CT near EOL is still poorly studied, with no dedicated study in gastrointestinal (GI) cancer patients. AIM To analyze in GI cancer patients the factors associated with the use of CT within 3- and 1-month before patients' death. METHODS AND PARTICIPANTS All consecutive patients who died from a GI cancer in 10 French tertiary care hospitals during 2014 were included in this retrospective study. Clinical, demographical and biological data were collected and compared between patients receiving or not CT within 3- and 1-month before death. Variables associated with overall survival (OS) was also determined using of univariate and multivariate analyses with a Cox model. RESULTS Four hundred and thirty-seven patients with a metastatic GI cancer were included in this study. Among them, 293 pts (67.0%) received CT within 3-months before death, and 121 pts (27.7%) received CT within 1-month before death. Patients receiving CT within 3-months before death were significantly younger (median age: 65.5 vs 72.8 years, p < 0.0001), with a better PS (PS 0 or 1: 53.9 vs 29.3%, p < 0.0001) and a higher albumin level (median: 32.8 vs 31.0 g/L, p = 0.048). Similar results were found for CT within 1 month before death. Palliative care team intervention was less frequent in patients who received CT in their last month of life (39.7% vs 51.3%, p = 0.02). In multivariate analysis, median OS from diagnosis was shorter in the group receiving CT within 1-month before death (HR = 0.59; 95% CI [0.48-0.74]). CONCLUSION In GI-cancer patients, CT is administered within 3- and 1-month before death, in two and one third of patients, respectively. Patients receiving CT within 1-month before death, had more aggressive disease with poor OS. Palliative care team intervention was associated with less administration of CT in the last month of life. These results highlight the need to better anticipate the time to stop CT treatment in the end-of-life and the importance of an active collaboration between oncology and palliative care teams.
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Affiliation(s)
- Alexandra Lapeyre-Prost
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Geraldine Perkins
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Marie Vallee
- Oncology Department, Poitiers University Hospital, Poitiers, France
| | - Astrid Pozet
- Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | - David Tougeron
- Gastroenterology Department, Poitiers University Hospital, Poitiers, France
| | - Marianne Maillet
- Department of Gastroenterology, St-Louis Hospital, AP-HP, Paris, France
| | - Christophe Locher
- Department of Gastroenterology, General Hospital of Meaux, Meaux, France
| | - Johann Dreanic
- Department of Gastroenterology, Cochin Hospital, AP-HP, Paris, France
| | - Jean-Louis Legoux
- Department of Gastroenterology and Digestive Oncology, Centre Hospitalier Regional, Orléans, France
| | - Astrid Lièvre
- Department of Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France; Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, Rennes, France
| | - Cedric Lecaille
- Department of Gastroenterology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Jean-Marc Sabate
- Department of Gastroenterology, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Florence Mary
- Gastroenterology and Digestive Oncology, CHU Avicenne, AP-HP, Bobigny, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France
| | | | - Florence Behal
- Palliative Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Bruno Landi
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France
| | - Julien Taieb
- Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.
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Single-institution analysis of the prevalence, indications and outcomes of end-of-life radiotherapy. Clin Transl Radiat Oncol 2021; 30:26-30. [PMID: 34286114 PMCID: PMC8273096 DOI: 10.1016/j.ctro.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Survival prognostication and patient selection remain challenging tasks. End-of-life radiotherapy until one week before death showed a patient benefit. Treatment prescribed within one week of death often had to be discontinued. Therapy needs to take into account patient preferences for the last phase of life.
Background Radiotherapy plays an important role for symptom control in advanced stage cancer patients. Yet patients need to be carefully selected, and its use and benefits must be weighed against time spent under treatment and patient priorities in the last phase of life. In this study, we assess prevalence, indications and outcomes of radiotherapy close to death. Methods We screened all radiotherapy treatments performed at the Department of Radiation Oncology of the University Hospital Zurich between January 2010 and December 2019 to identify those which occurred near patients’ end-of-life. Analyzed data was extracted from the database of the Comprehensive Cancer Center Zurich, the treatment planning system Aria® and the electronical medical records system KISIM®. Results Within 60 days of death, 377 radiotherapy courses were prescribed to 280 patients, which constitutes 3.4% of all radiotherapy courses administered over the last decade at our department. Within 60–31, 30–8, and 7–0 days to death 164, 159, and 54 radiotherapy courses were prescribed, respectively. The most frequent treatment sites were brain (N = 122, 32%) and bone (N = 119, 32%), and there was no statistically significant difference in treatment site between the three sub-groups. The most common regimen was 10x3Gy (N = 130, 35%) in all three sub-groups (p = 0.23). Radiotherapy finished more than one week before death was associated with high completion rates (>80%) and treatment benefit (>55%). Conclusion Patient selection and survival prognostication remains challenging for radiation oncologists. While radiotherapy achieved high completion and success rates until one week before death, treatment within one week of death should be restricted to carefully selected patients or avoided altogether.
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11
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Wadhwa D, Hausner D, Popovic G, Pope A, Swami N, Maganti M, Zimmermann C. Systemic Anti-Cancer Therapy Use in Palliative Care Outpatients With Advanced Cancer. J Palliat Care 2020; 36:78-86. [PMID: 33241732 DOI: 10.1177/0825859720975949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate factors associated with continuation of systemic anti-cancer therapy (SACT) after palliative care consultation, and SACT administration in the last 30 days of life, in outpatients with cancer referred to palliative care. Timing of referral was of particular interest. METHODS Patient, disease, and treatment-related factors associated with SACT before and after palliative care, and in the last 30 days of life, were identified using 3-level multinomial logistic regression. Referral to palliative care was categorized by time from death as early (>12 months), intermediate (6-12 months), and late (≤6 months). RESULTS Of the 337 patients, 240 (71.2%) received SACT for advanced cancer; of these, 126 (52.5%) received SACT only prior to palliative care while 114 (47.5%) also received SACT afterward. Only 35/337 (10.4%) received SACT in the last 30 days of life. On multivariable analysis, factors associated with continuing SACT after palliative care consultation were a cancer diagnosis for <1 year (OR 3.09, p = 0.01), breast primary (OR 11.88, p = 0.0008), and early (OR 28.8, p < 0.001) or intermediate (OR 6.67, p < 0.001) referral timing. No factors were significantly associated with receiving SACT in the last 30 days versus earlier, but the median time from palliative care referral to death in those receiving SACT in the last 30 days versus stopping SACT earlier was 1.78 versus 4.27 months. CONCLUSION Patients who received SACT following palliative care consultation were more likely to be referred early; however, patients receiving SACT in their last 30 days tended to be referred late.
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Affiliation(s)
- Deepa Wadhwa
- 25441BC Cancer-Kelowna, Kelowna, British Columbia, Canada.,Department of Supportive Care, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David Hausner
- Department of Supportive Care, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Palliative Care Service, Chaim 26744Sheba Medical Center, Ramat Gan, Israel
| | - Gordana Popovic
- Department of Supportive Care, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Manjula Maganti
- Department of Biostatistics, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, 10051Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Davis LE, Coburn NG, Hallet J, Earle CC, Liu Y, Myrehaug S, Mahar AL. Material deprivation and access to cancer care in a universal health care system. Cancer 2020; 126:4545-4552. [DOI: 10.1002/cncr.33107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Laura E. Davis
- Department of Epidemiology, Biostatistics, and Occupational Health McGill University Montreal Quebec Canada
| | - Natalie G. Coburn
- Division of Surgical Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
- ICES Toronto Ontario Canada
| | - Julie Hallet
- Division of Surgical Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
- ICES Toronto Ontario Canada
| | - Craig C. Earle
- ICES Toronto Ontario Canada
- Division of Medical Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | | | - Sten Myrehaug
- Division of Radiation Oncology Odette Cancer CentreSunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Alyson L. Mahar
- ICES Toronto Ontario Canada
- Department of Community Health Sciences University of Manitoba Winnipeg Manitoba Canada
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13
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Haukland EC, von Plessen C, Nieder C, Vonen B. Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care. BMC Palliat Care 2020; 19:76. [PMID: 32482172 PMCID: PMC7265218 DOI: 10.1186/s12904-020-00579-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care. METHODS Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. RESULTS 30% of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62% more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1000 patient days (p < 0.001, OR 1.62 (1.23-2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18% (p = 0.045, OR 1.85 (1.01-3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1000 patient days in both groups by 29% (p = 0.02, IRR 0.71, CI 95% 0.53-0.96). CONCLUSIONS Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.
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Affiliation(s)
- Ellinor Christin Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, PO Box 1480, 8092, Bodø, Norway. .,Institute of Community Medicine, The Arctic University of Norway, PO Box 6, 9038, Tromsø, Norway.
| | - Christian von Plessen
- Direction Générale de la Santé, Canton Vaud, Switzerland.,Unisanté, Direction Générale de la santé, Avenue de Casèrnes 2, 1018, Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, PO Box 1480, 8092, Bodø, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Barthold Vonen
- Institute of Community Medicine, The Arctic University of Norway, PO Box 6, 9038, Tromsø, Norway.,Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, PO Box 6, 9038, Tromsø, Norway
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14
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The prevalence of cancer associated systemic inflammation: Implications of prognostic studies using the Glasgow Prognostic Score. Crit Rev Oncol Hematol 2020; 150:102962. [PMID: 32344318 DOI: 10.1016/j.critrevonc.2020.102962] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023] Open
Abstract
The prognostic importance of SIR in patients with cancer is widely recognised. More recently it has become clear that the systemic inflammatory response is an important etiologic factor in the development of cancer cachexia. Two recent meta-analysis carried out in 2017 and 2018 were interrogated and the number of patients with specific cancer types were identified. The percentage of patients with operable cancer (n>28,000) who were systemically inflamed varied from 21% to 38%. The percentage of patients with inoperable cancer (n>12,000) who were systemically inflamed varied from 29% to 79%. Overall, the percentage of patients (n>40,000) who were systemically inflamed varied from 28% to 63% according to tumour type. The most commonly studied cancer was colorectal cancer (n∼10,000 patients) and 40% were systemically inflamed.
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15
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Hjermstad MJ, Aass N, Andersen S, Brunelli C, Dajani O, Garresori H, Hamre H, Haukland EC, Holmberg M, Jordal F, Krogstad H, Lundeby T, Løhre ET, Mjåland S, Nordbø A, Paulsen Ø, Schistad Staff E, Wester T, Kaasa S, Loge JH. PALLiON - PALLiative care Integrated in ONcology: study protocol for a Norwegian national cluster-randomized control trial with a complex intervention of early integration of palliative care. Trials 2020; 21:303. [PMID: 32241299 PMCID: PMC7118863 DOI: 10.1186/s13063-020-4224-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Several publications have addressed the need for a systematic integration of oncological care focused on the tumor and palliative care (PC) focused on the patient with cancer. The exponential increase in anticancer treatments and the high number of patients living longer with advanced disease have accentuated this. Internationally, there is now a persuasive argument that introducing PC early during anticancer treatment in patients with advanced disease has beneficial effects on symptoms, psychological distress, and survival. METHODS This is a national cluster-randomized trial (C-RCT) in 12 Norwegian hospitals. The trial investigates effects of early, systematic integration of oncology and specialized PC in patients with advanced cancer in six intervention hospitals compared with conventional care in six. Hospitals are stratified on the size of local catchment areas before randomization. In the intervention hospitals, a three-part complex intervention will be implemented. The backbone of the intervention is the development and implementation of patient-centered care pathways that contain early, compulsory referral to PC and regular and systematic registrations of symptoms. An educational program must be completed before patient inclusion. A total of 680 patients with advanced cancer and one caregiver per patient are included when patients come for start of last line of chemotherapy, defined according to national treatment guidelines. Data registration, clinical variables, and patient- and caregiver-reported outcomes take place every 2 months for 1 year or until death. The primary outcome is use of chemotherapy in the last 3 months of life by comparing the proportion of patients who receive this in the intervention and control groups. Primary outcome is use of chemotherapy in the last 3 months before death, i.e. number of patients. Secondary outcomes are initiation, discontinuation and number of cycles, last 3 months of life, administration of other medical interventions in the last month of life, symptom burden, quality of life (QoL), satisfaction with information and follow-up, and caregiver health, QoL, and satisfaction with care. DISCUSSION Results from this C-RCT will be used to raise the awareness about the positive outcomes of early provision of specialized palliative care using pathways for patients with advanced cancer receiving medical anticancer treatment. The long-term clinical objective is to integrate these patient-centered pathways in Norwegian cancer care. The specific focus on the patient and family and the organization of a predictable care trajectory is consistent with current Norwegian strategies for cancer care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03088202. Registered on 23 March 2017.
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Affiliation(s)
- Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Aass
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigve Andersen
- University Hospital of North Norway, Tromsø, Norway
- UiT, The Arctic University of Norway, Tromsø, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Herish Garresori
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Hanne Hamre
- Department of Oncology, Akershus University Hospital, Nordbyhagen, Norway
| | - Ellinor C. Haukland
- Department of Oncology and Palliative Care, Nordland Hospital Trust, Bodø, Norway
| | - Mats Holmberg
- Department of Oncology and Palliative Care, Førde Hospital Trust, Førde, Norway
| | - Frode Jordal
- Department of Clinical Oncology, Østfold Hospital Trust, Grålum, Norway
| | - Hilde Krogstad
- Cancer Clinic, St. Olavs hospital, Trondheim university hospital, Trondheim, Norway
| | - Tonje Lundeby
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Torbjørn Løhre
- Cancer Clinic, St. Olavs hospital, Trondheim university hospital, Trondheim, Norway
| | - Svein Mjåland
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
| | - Arve Nordbø
- Department of Oncology and Palliative Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | | | - Torunn Wester
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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16
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Hirvonen OM, Leskelä RL, Grönholm L, Haltia O, Rissanen A, Tyynelä-Korhonen K, Rahko EK, Lehto JT, Saarto T. Assessing the utilization of the decision to implement a palliative goal for the treatment of cancer patients during the last year of life at Helsinki University Hospital: a historic cohort study. Acta Oncol 2019; 58:1699-1705. [PMID: 31742490 DOI: 10.1080/0284186x.2019.1659512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life.Material and methods: Patients with a cancer diagnosis treated in tertiary hospital during 1st January 2013 - 31st December 2014 and deceased by the end of 2014 were identified in the hospital database (N = 2737). Of these patients, 992 were randomly selected for this study. The PC decision was screened from patient records, i.e., termination of cancer-specific treatments and a focus on symptom-centered PC.Results: The PC decision was defined in 82% of the patients during the last year of life (49% >30 days and 33% ≤30 days before death, 18% with no decision). The median time from the decision to death was 46 days. Systemic cancer therapy was given during the last month of life in 1%, 36% and 38% (p < .001) and radiotherapy 22%, 40% and 31% (p = .03) cases, respectively; referral to a PC unit was made in 62%, 22% and 11%, respectively (p < .001). In logistic regression analyses younger age, shorter duration of the disease trajectory and type of cancer (e.g., breast cancer) were associated with a lack or late timing of the PC decision.Conclusion: The decision to initiate a palliative goal for the treatment was frequently made for cancer patients but occurred late for every third patient. Younger age and certain cancer types were associated with late PC decisions, thus leading to anti-cancer treatments continuing until close to the death with low access to a PC unit.
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Affiliation(s)
- Outi M. Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | | | - Lotta Grönholm
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Olli Haltia
- Tuusula Health Care Centre, Tuusula, Finland
| | | | | | - Eeva K. Rahko
- Department of Clinical Oncology, Oulu University Hospital, Oulu, Finland
| | - Juho T. Lehto
- Department of Oncology, Palliative Care Unit, Tampere University Hospital and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Tiina Saarto
- Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
- Department of Palliative Care, Comprehensive Cancer Center, University of Helsinki, Helsinki, Finland
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Hylin H, Thrane H, Pedersen K, Kristiansen IS, Burger EA. The healthcare costs of treating human papillomavirus-related cancers in Norway. BMC Cancer 2019; 19:426. [PMID: 31064346 PMCID: PMC6505196 DOI: 10.1186/s12885-019-5596-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/10/2019] [Indexed: 12/24/2022] Open
Abstract
Background Public health efforts to prevent human papillomavirus (HPV)-related cancers include HPV vaccination and cervical cancer screening. We quantified the annual healthcare cost of six HPV-related cancers in order to provide inputs in cost-effectiveness analyses and quantify the potential economic savings from prevention of HPV-related cancers in Norway. Methods Using individual patient-level data from three unlinked population-based registries, we estimated the mean healthcare costs 1) annually across all phases of disease, 2) during the first 3 years of care following diagnosis, and 3) for the last 12 months of life for patients diagnosed with an HPV-related cancer. We included episodes of care related to primary care physicians, specialist care (private specialists and hospital-based care and prescriptions), and prescription drugs redeemed at pharmacies outside hospitals between 2012 and 2014. We valued costs (2014 €1.00 = NOK 8.357) based on diagnosis-related groups (DRG), patient copayments, reimbursement fees and pharmacy retail prices. Results In 2014, the total healthcare cost of HPV-related cancers amounted to €39.8 million, of which specialist care accounted for more than 99% of the total cost. The annual maximum economic burden potentially averted due to HPV vaccination will be lower for vulvar, penile and vaginal cancer (i.e., €984,620, €762,964 and €374,857, respectively) than for cervical, anal and oropharyngeal cancers (i.e., €17.2 million, €6.7 million and €4.6 million, respectively). Over the first three years of treatment following cancer diagnosis, patients diagnosed with oropharyngeal cancer incurred the highest total cost per patient (i.e. €49,774), while penile cancer had the lowest total cost per patient (i.e. €18,350). In general, costs were highest the first year following diagnosis and then declined; however, costs increased rapidly again towards end of life for patients who did not survive. Conclusion HPV-related cancers constitute a considerable economic burden to the Norwegian healthcare system. As the proportion of HPV-vaccinated individuals increase and secondary prevention approaches advance, this study highlights the potential economic burden avoided by preventing these cancers. Electronic supplementary material The online version of this article (10.1186/s12885-019-5596-2) contains supplementary material, which is available to authorized users.
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18
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Baena-Cañada JM, Campini Bermejo A, Gámez Casado S, Rodríguez Pérez L, Quílez Cutillas A, Calvete Candenas J, Martínez Bautista MJ, Benítez Rodríguez E. Experiences with Prescribing Large Quantities of Systemic Anticancer Therapy Near Death. J Palliat Med 2019; 22:1515-1521. [PMID: 31184989 DOI: 10.1089/jpm.2019.0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The most important decision after diagnosing terminal cancer is whether to provide active therapy or withhold treatment. Objective: To analyze the aggressiveness of care by evaluating systemic anticancer therapy (SACT) given near to death, describing this care and identifying factors that determine its use. Design: This involves retrospective observational cohorts study. Setting/Subjects: This involves patients with metastatic tumors who died at a University Hospital in Spain between 2015 and 2016. Measurements: Data obtained from prescribing oncologists and patients' clinical records, type of cancer, and information on treatment. The dependent variable used was the interval between the date of the last dose and date of death. Results: Ninety-four (32.60%) of 288 patients received SACT in the last month of life. This cohort had a higher frequency of lung cancer (OR: 1.58; CI 95%: 1.14-2.18), received more care from oncologist 2 (OR: 1.50; CI 95%: 1.08-2.08), had fewer last-line treatment cycles (OR: 1.28; CI 95%: 1.13-1.45), a lower subjective response (OR: 3.13; CI 95%: 1.34-7.29), less clinical benefit (OR: 2.38; CI 95%: 1.04-5.55), more visits to the Emergency Department (OR: 1.59; CI 95%: 1.06-2.38), and less care from the Palliative Care Unit (OR: 4.55; CI 95%: 2.69-7.70). In multivariate analysis, the predictors of having received SACT close to death remained: receiving fewer cycles of treatment (OR: 1.28; CI 95%: 1.12-1.47) and less palliative care (OR: 4.54; CI 95%: 2.56-7.69). Conclusions: A third of cancer patients received SACT in the last month of life with less efficacy and poorer quality of care than patients not receiving it.
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Affiliation(s)
- José M Baena-Cañada
- Medical Oncology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
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19
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Palliative thoracic radiotherapy near the end of life in lung cancer: A population-based analysis. Lung Cancer 2019; 135:97-103. [PMID: 31447009 DOI: 10.1016/j.lungcan.2019.02.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Palliative thoracic radiotherapy (RT) can improve quality of life for patients with advanced lung cancer, but treatment can be associated with acute toxicity and symptomatic relief may take several weeks. The optimal fractionation schedule is not known. Delivery of RT near the end of life (EOL) is an emerging indicator of poor quality care. The aim of this study was to determine utilization of palliative thoracic RT in the last 4 weeks of life, and factors associated with its use, in patients with incurable lung cancer in a population-based healthcare system. MATERIALS AND METHODS All patients with lung cancer in British Columbia treated with palliative thoracic RT in 2014 and 2015 were identified. Associations between starting a course of palliative thoracic RT within 4 weeks of death and patient/treatment characteristics were assessed using univariate and multivariate logistic regression analysis. RESULTS 1676 courses of palliative thoracic RT were delivered to 1584 lung cancer patients. Median survival was 20 weeks. 12% of palliative thoracic RT courses were delivered in the last 4 weeks of life, with short fractionation schedules and simple RT planning techniques used more frequently near EOL. Of RT courses delivered in the last 4 weeks of life 89% were courses of 1 - 5 fractions, 75% were completed as prescribed and 94% involved simple 1-2 field RT techniques. Receipt of RT in the last 4 weeks of life was associated with male gender, younger age, poor performance status, metastatic disease, small cell carcinoma histology and no prior chemotherapy. CONCLUSION Further study and standardization of quality indicators for palliative RT utilization near EOL is required. Whilst clarification occurs, physicians should consider the prognosis of patients with incurable lung cancer and the realistic expectation of benefit from palliative thoracic RT when considering treatment indications and fractionation schedules.
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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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21
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Zhang Z, Chen ML, Gu XL, Liu MH, Zhao WW, Cheng WW. Palliative Chemotherapy Near the End of Life in Oncology Patients. Am J Hosp Palliat Care 2018. [PMID: 29529885 DOI: 10.1177/1049909118763338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL. METHODS This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy. RESULTS Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001). CONCLUSION The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.
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Affiliation(s)
- Zhe Zhang
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Meng-Lei Chen
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Li Gu
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ming-Hui Liu
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei-Wei Zhao
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Wu Cheng
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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22
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Park KR, Lee CG, Tseng YD, Liao JJ, Reddy S, Bruera E, Yennurajalingam S. Palliative radiation therapy in the last 30 days of life: A systematic review. Radiother Oncol 2017; 125:193-199. [DOI: 10.1016/j.radonc.2017.09.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 12/18/2022]
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23
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Rautakorpi LK, Mäkelä JM, Seyednasrollah F, Hammais AM, Laitinen T, Hirvonen OM, Minn H, Elo LL, Jyrkkiö SM. Assessing the utilization of radiotherapy near end of life at a Finnish University Hospital: a retrospective cohort study. Acta Oncol 2017; 56:1265-1271. [PMID: 28503990 DOI: 10.1080/0284186x.2017.1324638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Palliative radiotherapy can improve quality of life for cancer patients during the last months of life. However, very short life expectancy may devastate the benefit of the treatment. This single center study assesses the utilization of radiotherapy during the last weeks of life. MATERIAL AND METHODS All cancer patients (N = 38,982) treated with radiotherapy (N = 11,395) in Turku University Central Hospital during 2005-2013 were identified in the database consisting of electronic patient records. One fourth (N = 2904, 25.5%) of the radiotherapy treatments were given during the last year of life. The last radiotherapy treatments and the time from the last radiotherapy treatment to death were assessed in regards to patients' age, cancer diagnosis, domicile, place of death and the treatment year. Treatments given during the last two weeks of life were also assessed regarding the goal of treatment and the reason for possible discontinuation. RESULTS The median time from the last fraction of radiotherapy to death was 84 d. During the last two weeks before death (N = 340), pain (29.4%) was the most common indication for radiotherapy. Treatment was discontinued in 40.6% of the patients during the last two weeks of life, and worsening of general condition was the most common reason for discontinuity (70.3%). The patients receiving radiotherapy during the last weeks of life were more likely to die in tertiary care unit. During the last year of life single-fraction treatment was used only in 7% of all therapy courses. There was a statistically significant (p < .05) decrease in the median number of fractions in the last radiotherapy treatment between 2005-2007 (8 fractions) and 2011-2013 (6 fractions). CONCLUSIONS Up to 70% of the treatments during the last two weeks of life were not delivered to alleviate pain and utilization of single fraction radiotherapy during the last year of life was infrequent. These observations suggest that practice of radiotherapy during the last weeks of life should be revisited.
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Affiliation(s)
- Liisa K. Rautakorpi
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | - Johanna M. Mäkelä
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi, Turku, Finland
| | - Fatemeh Seyednasrollah
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi, Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Anna M. Hammais
- Center for Clinical Informatics, Turku University Hospital, Turku, Finland
| | - Tarja Laitinen
- Center for Clinical Informatics, Turku University Hospital, Turku, Finland
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland
| | - Outi M. Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | - Heikki Minn
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | - Laura L. Elo
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi, Turku, Finland
| | - Sirkku M. Jyrkkiö
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
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24
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Rautakorpi LK, Seyednasrollah F, Mäkelä JM, Hirvonen OM, Laitinen T, Elo LL, Jyrkkiö SM. End-of-life chemotherapy use at a Finnish university hospital: a retrospective cohort study. Acta Oncol 2017; 56:1272-1276. [PMID: 28562152 DOI: 10.1080/0284186x.2017.1332424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent trends in the end-of-life (EOL) cancer care have suggested that the levels of treatment are becoming more aggressive. The aim of this single-center study was to evaluate the time from the last intravenous (IV) chemotherapy treatment to death and identify factors correlating with treatment closer to death. MATERIAL AND METHODS The study included all patients diagnosed with cancer at Turku University Central Hospital between the years 2005 and 2013 (N = 38,982) who received IV chemotherapy during the last year of life (N = 3285). The cohort of patients and their respective clinical information were identified from electronic medical records. Statistical analysis was performed to assess and compare the treatment strategies, taking into account the patient's age, the year they were treated, and the type of cancer they were diagnosed with. RESULTS A total of 11,250 cancer patients died during the observation time and one-third (N = 3285, 29.2%) of them had received IV chemotherapy during the last year of life. The time from the last IV chemotherapy regimen to death remained consistent across the follow-up time. During the last month of life, every third patient under the age of 50 years and only one-tenth of patients over the age of 80 years received IV chemotherapy. Hematological malignancies and lymphomas were treated closer to death when compared to other diagnostic groups. CONCLUSIONS During the period of 9 years, the pattern of EOL IV chemotherapy treatment remained stable. Every third patient died at tertiary care. Only 7.2% of patients who received IV chemotherapy during the last year of life were treated 14 days before death, which is in line with international recommendations. However, significant variation in EOL treatment strategies between different diagnosis and age groups were identified.
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Affiliation(s)
- Liisa K. Rautakorpi
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Fatemeh Seyednasrollah
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi, Turku, Finland
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Johanna M. Mäkelä
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi, Turku, Finland
| | - Outi M. Hirvonen
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
- Department of Clinical Oncology, University of Turku, Turku, Finland
| | - Tarja Laitinen
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Clinical Informatics, Turku University Hospital, Turku, Finland
| | - Laura L. Elo
- Turku Centre for Biotechnology, University of Turku and Åbo Akademi, Turku, Finland
| | - Sirkku M. Jyrkkiö
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
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25
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Mathew A, Achkar T, Abberbock S, Sandhu GS, Jacob ME, Villgran VD, Rosenzweig MQ, Puhalla S, Brufsky AM. Prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer. Breast J 2017; 23:718-722. [PMID: 28845536 DOI: 10.1111/tbj.12905] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/01/2022]
Abstract
Cessation of chemotherapy in the last few weeks of life could be an important quality-of-care benchmark. Proportion of metastatic breast cancer patients who receive end-of-life chemotherapy is not well described. We aimed to determine the prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer. A retrospective cohort study using a prospectively collated database of patients with metastatic breast cancer who died between January 1, 2010, and September 30, 2014, was conducted. End-of-life chemotherapy (EOLC) use was defined as receipt of chemotherapy within 2 weeks of death (EOLC2) and receipt of chemotherapy within 4 weeks of death (EOLC4). Patients who did not receive any chemotherapy in the last 4 weeks before death were categorized as non-EOLC. We identified 274 patients with metastatic breast cancer, of whom 28 received EOLC2 (10.2%) and 62 received EOLC4 (22.6%). In comparison with non-EOLC, patients receiving EOLC4 were younger and had greater disease burden. Patients in EOLC4 group received more number of lines of chemotherapy. In a multivariable analysis, younger age at metastatic disease and greater number of metastatic organ systems involved were predictors of end-of-life chemotherapy use. Prevalence of the use of end-of-life chemotherapy in our cohort was higher than previously described. More end-of-life chemotherapy was used in younger women, and those with greater disease burden. Earlier initiation of end-of-life discussions may be targeted to such patients.
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Affiliation(s)
- Aju Mathew
- University of Kentucky, Markey Cancer Center, Lexington, KY, USA
| | - Tala Achkar
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | - Shira Abberbock
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | | | | | - Vipin Das Villgran
- University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
| | | | - Shannon Puhalla
- Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam M Brufsky
- University of Pittsburgh Magee Women's Hospital, Pittsburgh, PA, USA
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26
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Ong WL, Khor R, Bressel M, Tran P, Tedesco J, Tai KH, Ball D, Duchesne G, Foroudi F. Patterns of health services utilization in the last two weeks of life among cancer patients: Experience in an Australian academic cancer center. Asia Pac J Clin Oncol 2017; 13:400-406. [DOI: 10.1111/ajco.12701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 04/08/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Wee Loon Ong
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Victoria Australia
- Department of Radiation Oncology; Olivia Newton John Cancer Centre/Austin Health; Heidelberg Victoria Australia
| | - Richard Khor
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Radiation Oncology; Olivia Newton John Cancer Centre/Austin Health; Heidelberg Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
| | - Mathias Bressel
- Department of Biostatistics and Clinical Trial; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Phillip Tran
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Jo Tedesco
- Department of Medical Radiations; Monash University; Melbourne Australia
| | - Keen Hun Tai
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
| | - Gillian Duchesne
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
- Department of Medical Radiations; Monash University; Melbourne Australia
| | - Farshad Foroudi
- Division of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Radiation Oncology; Olivia Newton John Cancer Centre/Austin Health; Heidelberg Victoria Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Melbourne Australia
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27
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Nieder C, Mannsåker B, Dalhaug A, Pawinski A, Haukland E. The Glasgow prognostic score: Useful information when prescribing palliative radiotherapy. Mol Clin Oncol 2017; 6:811-816. [PMID: 28588769 PMCID: PMC5451880 DOI: 10.3892/mco.2017.1228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/10/2017] [Indexed: 12/28/2022] Open
Abstract
The purpose of the present retrospective study was to investigate whether a score reflecting systemic inflammatory processes [the Glasgow Prognostic Score (GPS)] provides relevant information for radiation oncologists. GPS is a three-tiered score [0: normal C-reactive protein (CRP) and albumin; 1: one abnormal result; 2: increased CRP and low albumin]. Correlations between disease type and extent, resource utilization, survival and GPS were analyzed in 703 patients. In the subgroup with GPS 2, significantly higher rates of lung, adrenal gland and liver metastases were observed. An increasing GPS score was associated with a higher likelihood of anemia, leukocytosis and thrombocytosis. Comparable findings were made regarding utilization of palliative care resources, need for blood transfusion and intravenous administration of antibiotics. Compared with GPS 0 or 1, more patients with GPS 2 did not complete their prescribed course of radiotherapy. One-third of patients with GPS 2 received treatment during the final month of life. Multivariate analysis demonstrated that GPS was a significant prognostic factor for overall survival (median, 479, 136, and 61 days, for GPS 0, 1 and 2, respectively). In patients with GPS 2 and additional leukocytosis, the median survival was 38 days. In conclusion, GPS provides important prognostic information. This biomarker-based score may be considered for deciding fractionation, and should be validated further.
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Affiliation(s)
- Carsten Nieder
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037 Tromsø, Norway.,Department of Oncology and Palliative Medicine, Nordland Hospital, N-8092 Bodø, Norway
| | - Bård Mannsåker
- Department of Oncology and Palliative Medicine, Nordland Hospital, N-8092 Bodø, Norway
| | - Astrid Dalhaug
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037 Tromsø, Norway.,Department of Oncology and Palliative Medicine, Nordland Hospital, N-8092 Bodø, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, N-8092 Bodø, Norway
| | - Ellinor Haukland
- Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, N-9037 Tromsø, Norway.,Department of Oncology and Palliative Medicine, Nordland Hospital, N-8092 Bodø, Norway
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28
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Simmons CPL, McMillan DC, McWilliams K, Sande TA, Fearon KC, Tuck S, Fallon MT, Laird BJ. Prognostic Tools in Patients With Advanced Cancer: A Systematic Review. J Pain Symptom Manage 2017; 53:962-970.e10. [PMID: 28062344 DOI: 10.1016/j.jpainsymman.2016.12.330] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/18/2016] [Accepted: 12/23/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE In 2005, the European Association for Palliative Care made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved, and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools. METHODS Medline, Embase Classic and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer, >18 years, original studies, population n ≥100, and published after 2003. Descriptive and quantitative statistical analyses were performed. RESULTS Forty-nine studies were eligible, assessing seven prognostic tools across different care settings, primary cancer types, and statistically assessed survival prediction. The Palliative Performance Scale was the most studied (n = 21,082), comprising six parameters (six subjective), was externally validated, and predicted survival. The Palliative Prognostic Score composed of six parameters (four subjective and two objective), the Palliative Prognostic Index composed of nine parameters (nine subjective), and the Glasgow Prognostic Score composed of two parameters (two objective) and were all externally validated in more than 2000 patients with advanced cancer and predicted survival. CONCLUSION Various prognostic tools have been validated but vary in their complexity, subjectivity, and therefore clinical utility. The Glasgow Prognostic Score would seem the most favorable as it uses only two parameters (both objective) and has prognostic value complementary to the gold standard measure, which is performance status. Further studies comparing all proved prognostic markers in a single cohort of patients with advanced cancer are needed to determine the optimal prognostic tool.
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Affiliation(s)
| | | | | | | | | | | | | | - Barry J Laird
- University of Edinburgh, Edinburgh, UK; European Palliative Care Research Centre, Norwegian University of Science and Technology, Trondheim, Norway.
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29
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Jonna S, Chiang L, Liu J, Carroll MB, Flood K, Wildes TM. Geriatric assessment factors are associated with mortality after hospitalization in older adults with cancer. Support Care Cancer 2016; 24:4807-13. [PMID: 27465048 DOI: 10.1007/s00520-016-3334-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/10/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Survival in older adults with cancer varies given differences in functional status, comorbidities, and nutrition. Prediction of factors associated with mortality, especially in hospitalized patients, allows physicians to better inform their patients about prognosis during treatment decisions. Our objective was to analyze factors associated with survival in older adults with cancer following hospitalization. METHODS Through a retrospective cohort study, we reviewed 803 patients who were admitted to Barnes-Jewish Hospital's Oncology Acute Care of Elders (OACE) unit from 2000 to 2008. Data collected included geriatric assessments from OACE screening questionnaires as well as demographic and medical history data from chart review. The primary end point was time from index admission to death. The Cox proportional hazard modeling was performed. RESULTS The median age was 72.5 years old. Geriatric syndromes and functional impairment were common. Half of the patients (50.4 %) were dependent in one or more activities of daily living (ADLs), and 74 % were dependent in at least one instrumental activity of daily living (IADLs). On multivariate analysis, the following factors were significantly associated with worse overall survival: male gender; a total score <20 on Lawton's IADL assessment; reason for admission being cardiac, pulmonary, neurologic, inadequate pain control, or failure to thrive; cancer type being thoracic, hepatobiliary, or genitourinary; readmission within 30 days; receiving cancer treatment with palliative rather than curative intent; cognitive impairment; and discharge with hospice services. CONCLUSIONS In older adults with cancer, certain geriatric parameters are associated with shorter survival after hospitalization. Assessment of functional status, necessity for readmission, and cognitive impairment may provide prognostic information so that oncologists and their patients make more informed, individualized decisions.
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Affiliation(s)
- Sushma Jonna
- Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8056, St Louis, MO, 63110, USA
| | - Leslie Chiang
- University of California San Diego, San Diego, CA, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA
| | - Maria B Carroll
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Kellie Flood
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanya M Wildes
- Department of Medicine, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8056, St Louis, MO, 63110, USA.
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30
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Hjermstad MJ, Aass N, Aielli F, Bennett M, Brunelli C, Caraceni A, Cavanna L, Fassbender K, Feio M, Haugen DF, Jakobsen G, Laird B, Løhre ET, Martinez M, Nabal M, Noguera-Tejedor A, Pardon K, Pigni A, Piva L, Porta-Sales J, Rizzi F, Rondini E, Sjøgren P, Strasser F, Turriziani A, Kaasa S. Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research. BMJ Support Palliat Care 2016; 8:456-467. [PMID: 27246166 DOI: 10.1136/bmjspcare-2015-000997] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. METHODS This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme. RESULTS 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001). CONCLUSIONS There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT01362816.
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Affiliation(s)
- M J Hjermstad
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - N Aass
- Department of Oncology, Regional Centre for Excellence in Palliative Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - F Aielli
- Medical Oncology Department, University of L'Aquila, L'Aquila, Italy
| | - M Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - C Brunelli
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Caraceni
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Cavanna
- Oncology-Hematology Department, Hospital of Piacenza, Piacenza, Italy
| | - K Fassbender
- Cross Cancer Institute, Regional Cancer Centre Northern Alberta, Edmonton, Alberta, Canada
| | - M Feio
- Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal
| | - D F Haugen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - G Jakobsen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - B Laird
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - E T Løhre
- Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M Martinez
- Clínica Universidad de Navarra, Pamplona, Spain
| | - M Nabal
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | | | - K Pardon
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - A Pigni
- Pain Therapy and Rehabilitation Unit, Department of Palliative Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Piva
- Unità di Cure Palliative Azienda Ospedaliera San Paolo, Milan, Italy
| | - J Porta-Sales
- Palliative Care Service, Catalan Institute of Oncology (ICO), Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), WeCare Chair: end of life care, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - F Rizzi
- U.O. Complessa Cure Palliative e Terapia del Dolore Istituti Clinici di Perfezionamento, Milan, Italy
| | - E Rondini
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - P Sjøgren
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - F Strasser
- Oncological Palliative Medicine, Oncology Department, Internal Medicine & Palliative Centre Cantonal Hospital, St. Gallen, Switzerland
| | - A Turriziani
- Hospice Villa Speranza, Università Cattolica S. Cuore, Rome, Italy
| | - S Kaasa
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, European Palliative Care Research Centre, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Cancer Clinic, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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31
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Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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Nieder C, Angelo K, Dalhaug A, Pawinski A, Haukland E, Norum J. Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists. Oncol Lett 2015; 10:3043-3049. [PMID: 26722287 DOI: 10.3892/ol.2015.3656] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 08/05/2015] [Indexed: 12/12/2022] Open
Abstract
Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.
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Affiliation(s)
- Carsten Nieder
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway ; Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Kent Angelo
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway
| | - Astrid Dalhaug
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway ; Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Adam Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Nordland 8092, Norway
| | - Jan Norum
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø - The Arctic University of Norway, Tromsø, Troms 9037, Norway ; Department of Radiology, University Hospital of North Norway, Tromsø, Troms 9038, Norway
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33
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Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ, Garrido MM, Reid MC, Berlin DA, Adelson KB, Neugut AI, Maciejewski PK. Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. JAMA Oncol 2015; 1:778-84. [PMID: 26203912 PMCID: PMC4828728 DOI: 10.1001/jamaoncol.2015.2378] [Citation(s) in RCA: 401] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status. OBJECTIVE To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States. MAIN OUTCOMES AND MEASURES Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week. RESULTS Chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59). CONCLUSIONS AND RELEVANCE Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.
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Affiliation(s)
- Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York2Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Manish A Shah
- Meyer Cancer Center of Weill Cornell Medical College, Medical Oncology/Solid Tumor Program, New York, New York
| | - M Elizabeth Paulk
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Thomas W LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Melissa M Garrido
- James J. Peters VA Medical Center, Bronx, New York9Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - David A Berlin
- Department of Medicine, Medical Intensive Care Unit, New York Presbyterian Hospital-Weill Cornell Center, New York
| | - Kerin B Adelson
- Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut
| | - Alfred I Neugut
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York12Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Paul K Maciejewski
- Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York14Department of Radiology, Weill Cornell Medical College, New York, New York
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