Too Much Too Late? Chemotherapy Administration at the End of Life: A Retrospective Observational Study

2020 ◽  
pp. 104990912096661
Author(s):  
David H. Wilkerson ◽  
Jennifer L. Santos ◽  
Xiyan Tan ◽  
Teny Henry Gomez
Keyword(s):  
Palliative Care ◽  
Cancer Treatment ◽  
End Of Life ◽  
Cancer Care ◽  
Advanced Directives ◽  
Palliative Intent ◽  
Chemotherapy Administration ◽  
Quality Cancer Care ◽  
Aggressive Cancer

Purpose: Cancer treatment for those nearing death has become increasingly aggressive over time despite evidence that less aggressive approaches are associated with better quality of life and sometimes longer survival. Chemotherapy administration in the last 14 days of life is one of the proposed benchmarks for quality of cancer care. The purpose of our study is to evaluate factors associated with aggressive cancer treatment in patients who died within 2 weeks of receiving chemotherapy. Methods: This retrospective cohort study evaluated adult patients who died between 1 February 2018 and 1 March 2019 after receiving cancer treatment in the preceding 14 days at the Prisma Health Cancer Institute. This project was approved by our institutional review board. Data was obtained by review of electronic medical records and analyzed using commercial software. Results: We identified 92 patients who met inclusion criteria for the study. Of those who were staged, 57% had metastatic disease. A majority received treatments with only palliative intent (54%). These patients overwhelmingly died in the hospital (62%). Few had documented advanced directives (28%) or dedicated palliative care for longer than 1 week (28%). Overall, this cohort reflects a rate of 11.7% of patients who received cancer treatment during the study time period. Significance of Results: Patients receiving aggressive cancer treatment at the end of life elucidate significant gaps in quality cancer care, particularly the early involvement of dedicated palliative care. Systematic review helped identify multiple gaps and assisted in implementing interventions to improve this outcome.

Chemotherapy use at the end of life in Brazil.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24003-e24003
Author(s):  
Munir Murad Junior ◽  
Thiago Henrique Mascarenhas Nébias ◽  
Marcos Antonio da Cunha Santos ◽  
Mariangela Cherchiglia
Keyword(s):  
Palliative Care ◽  
Cancer Treatment ◽  
End Of Life ◽  
Cancer Patients ◽  
Stage Iv ◽  
Breast Cancers ◽  
Early Palliative Care ◽  
Study Population ◽  
One Year

e24003 Background: Chemotherapy in the last days of life is not associated with a survival benefit, and recent data suggest it may cause harm by decreasing quality of life and increasing costs. Both ESMO and ASCO have published position statements encouraging discussions about the appropriate cessation of chemotherapy. End-of-life chemotherapy rates vary worldwide but in summary, up to a fifth of cancer patients are treated with chemotherapy in the last month of life with no clear benefits. The aim of this study is to describe the rate of chemotherapy use in the last month of life in patients who are candidates for palliative care in Brazil. Methods: It is a prospective non-concurrent cohort carried out from a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System. The study population is composed of all patients who started cancer treatment between 2009 and 2014 and who was hospitalized at least 1 time after starting treatment. To address the indication for palliative care, patients whose death occurred within one year after the first hospitalization were selected. Results: A total of 299,202 patients started cancer treatment in that period and 62,249 died 1year after hospitalization. Among the deceased patients, the median age was 62 years, 50.9% of them were in stage IV and 34.1% in stage III and 46% lived in the southeastern region of the country. The most common cancers were lung (n = 17805; 28.6%) colorectal (n = 12273; 19.7%) and gastric (n = 10248; 16.5%). The average number of hospitalizations was 2.7 and 89% of these patients required emergency hospitalization. About half (45,4%; n=28,250) of the patients underwent chemotherapy at the last 30 days of life. The rates of use of chemotherapy in the last month was 44% for lung cancer, 74,4% for colon, 50.2% for gastric and 51.8% breast cancers. Conclusions: Despite international recommendations on the use of chemotherapy at the end of life, this seems to be a common practice unfortunately. Measures to implement early palliative care should be a priority for the care of cancer patients in Brazil.

Duration of palliative care involvement and cancer care aggressiveness near the end of life

2020 ◽  
pp. bmjspcare-2020-002641
Author(s):  
Pierre Antoine Monier ◽  
Jan Chrusciel ◽  
Fiona Ecarnot ◽  
Eduardo Bruera ◽  
Stephane Sanchez ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Teaching Hospital ◽  
Cancer Care ◽  
Data Privacy ◽  
National Commission ◽  
Care Group ◽  
Location Of Death ◽  
Aggressive Cancer ◽  
Hospital Ethics

ObjectivesPrevious studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care.MethodsWe performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life.ResultsAmong the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001).ConclusionMore studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care.Ethics approvalThe study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l’Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.

scholarly journals A Second Time Nationwide Survey of Quality of End-of-Life Cancer Care in General Hospitals, Inpatient Palliative Care Units, and Clinics in Japan: The J-HOPE 2 Study

2016 ◽  
Vol 11 (4) ◽  
pp. 254-264 ◽  
Author(s):  
Megumi Shimizu ◽  
Maho Aoyama ◽  
Tatsuya Morita ◽  
Satoru Tsuneto ◽  
Yasuo Shima ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Care ◽  
Nationwide Survey ◽  
General Hospitals ◽  
Palliative Care Units

Family Perspectives on Aggressive End-of-Life Care (DRAFT)

2018 ◽  
Author(s):  
Ravi B. Parikh ◽  
Oreofe Odejide
Keyword(s):  
End Of Life ◽  
Cancer Care ◽  
End Of Life Care ◽  
Family Members ◽  
Life Care ◽  
Aggressive Cancer ◽  
Care Family ◽  
Bereaved Family ◽  
The Impact

The chapter describes the study by Wright and colleagues examining the impact of aggressive cancer care on bereaved family members’ perceptions of end-of-life care. Family members of patients with advanced-stage lung or colorectal cancer were interviewed after their loved ones died to elicit perceptions of care. This chapter presents family-member reported rating of quality of end-of-life care and the association of such rating with aggressive cancer care, including intensive care unit admission within 30 days of death, and no hospice or late hospice admission. It also reviews family members’ perception of whether patients received end-of-life care that was concordant with their wishes. This chapter highlights the downstream impact of aggressive cancer care on family members and the resulting implications for end-of-life care.

scholarly journals Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool

2018 ◽  
pp. 1-9
Author(s):  
Chika R. Nwachukwu ◽  
Omobola Mudasiru ◽  
Lynn Million ◽  
Shruti Sheth ◽  
Hope Qamoos ◽  
...  
Keyword(s):  
Palliative Care ◽  
Needs Assessment ◽  
Cancer Care ◽  
Assessment Tool ◽  
Hospital Staff ◽  
Teaching Hospitals ◽  
High Quality ◽  
Middle Income ◽  
Quality Cancer Care ◽  
Oncology Care

Purpose Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation. Methods Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable. Results Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals. Conclusion This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.

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