Characteristics of patients (pts) receiving end of life treatment (EOLT) at an NCI-Designated Cancer Center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18245-e18245
Author(s):  
Kevin Do ◽  
Sarmad Sadeghi ◽  
Peggy Matsuura ◽  
Gwendoyn Lynch ◽  
Afsaneh Barzi
Keyword(s):  
End Of Life ◽  
Cancer Diagnosis ◽  
Expert Panel ◽  
Renal Cell Carcinoma Patient ◽  
Cancer Center ◽  
P Value ◽  
Cancer Subtype ◽  
Chi Squared ◽  
To Receive ◽  
End Of Life Treatment

e18245 Background: End of life treatment is identified as a high cost low return intervention and is under evaluation as a quality measure for providers. A 2012 ASCO expert panel acknowledged it as the most wasteful practice in oncology. However, characteristics of pts who receive EOLT is poorly described and so interventions to assist providers avoid such treatments are limited. Methods: We identified 299 pts with cancer diagnosis from 2008-2012 and confirmed deceased using our cancer registry. Pts charts were reviewed for last cancer-specific treatments, either chemotherapy (CTX) or radiation therapy (XRT). Characteristics of pts who received treatment within the last 90, 30, and 14 days of life was described. We compared the characteristics of those who received treatment with in the last 14 days of life (here defined as EOLT) to the rest of the population. Chi-squared tests were used to compare between groups. Results: 292 pts (98%) received CTX or XRT within the last 90 days of life, 167 (56%) received treatment within the last 30 days, and 78 (26%) within the last 14 days of life. The main modality of EOLT was CTX (99%). By cancer subtype, up to 50% of gastric and renal cell carcinoma patient received treatment in the last 14 days of life. Older pts, those on clinical trials, and those with longer period of time between diagnosis and death, were less likely to receive EOLT. There is a trend for receipt of EOLT for female pts and those younger than 65 years (p-value 0.059) Conclusions: Our data establishes that more than 25% of deceased pts received treatment in the last 14 days of life. Certain characteristics may influence providers to be aggressive and to deliver care when it is futile. Research to risk stratify pts who are good candidates for treatment is necessary and can improve the value of care delivered to these subjects.

Prognostic significance of the “surprise” question in cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9588-9588
Author(s):  
A. H. Moss ◽  
J. R. Lunney ◽  
S. Culp ◽  
M. Auber ◽  
S. Kurian ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Prognostic Significance ◽  
Cox Proportional Hazards ◽  
Cancer Center ◽  
P Value ◽  
Cancer Type ◽  
Patient Death ◽  
Surprise Question

9588 Background: In patients with advanced cancer, failure to accurately estimate and communicate prognoses can lead to overly aggressive care at the end of life with less attention to important palliative care issues such as pain and symptom management and patients’ values and goals for care. The “surprise” question—would I be surprised if this patient died in the next year?—has been recognized as an innovation to improve end-of-life care in the primary care population by identifying patients with a poor prognosis who are appropriate for palliative care. It has not been previously tested in cancer patients. The purposes of this study were to determine the feasibility and outcomes of the use of the “surprise” question in a cancer center population. Methods: Between July and November 2007, oncologists prospectively classified consecutive breast, lung, and colon cancer patients being seen at the Mary Babb Randolph Cancer Center of West Virginia University into “Yes” and “No” groups based on the surprise question. Patients were followed and their status at the end of one year-alive or dead-was determined along with patient demographics, type of cancer, and stage at presentation. A multivariate Cox proportional hazards regression analysis was used to identify variables associated with patient death. Results: Oncologists classified 826 of 853 prospective patients (97%), with 131 (16%) classified into the “No” group and 695 (84%) into the “Yes” group. At the end of the year, 71 patients had died; 41% of the “No” patients compared to 3% of the “Yes” patients (P <.001). The surprise question ‘No‘ response was more predictive of patient death than stage of cancer, cancer type, or age (hazard ratio 7.53, P value <.001). The “Yes” patients lived longer than the “No” patients (359.8±32.8 days versus 270±131.5 days, P <.001). The sensitivity of the surprise question “No” response was 75% and the specificity was 90%. Conclusions: We conclude that the surprise question is a simple, feasible, and effective tool to identify cancer patients with the worst prognoses who should receive the highest priority for palliative care interventions, particularly advance care planning. No significant financial relationships to disclose.

End-of-Life Treatment Preferences Among Older Adults

2001 ◽  
Vol 8 (6) ◽  
pp. 533-543 ◽  
Author(s):  
Eun-Shim Nahm ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Health Care Providers ◽  
Retirement Community ◽  
Treatment Preferences ◽  
Continuing Care ◽  
Care Providers ◽  
Aggressive Interventions ◽  
To Receive ◽  
End Of Life Treatment

With the advancement of medical technology, various life-sustaining treatments are available at the end of life. Older adults should be encouraged to establish their end-of-life treatment preferences (ELTP) while they are physically and mentally able to do so. The purpose of this study was to explore ELTP among older adults and to compare those preferences in a subset of individuals who had reported their ELTP in a survey completed the previous year. This was a descriptive study of 191 older adults living in a continuing care retirement community. Approximately half of the participants did not want cardiopulmonary resuscitation, to be put on a respirator, or to receive dialysis. The findings in this study suggest that many older adults do not want aggressive interventions at the end of life, but choose rather those measures that will keep them comfortable. Moreover, treatment choices may change over time. Health care providers should initiate discussions about ELTP at regular intervals (yearly) to assist older adults in dictating their end-of-life care.

Chemotherapy within the last 30 days of life among patients with metastatic solid tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16574-e16574
Author(s):  
Maria Alma Rodriguez ◽  
Yvette DeJesus ◽  
Lee Cheng ◽  
Thomas W. Burke
Keyword(s):  
End Of Life ◽  
Solid Tumors ◽  
Statistical Significance ◽  
Stage Iv ◽  
Disease Diagnosis ◽  
Administrative Databases ◽  
Cancer Center ◽  
P Value ◽  
Therapeutic Goals ◽  
Dnr Orders

e16574 Background: Metastatic solid tumors (MST) are rarely curable. However, treatment options for MST (stage IV) are increasing. Thus, discussing realistic therapeutic goals is critical to planning appropriate end of life medical interventions. We analyzed chemotherapy use within 30 days prior to end of life, and DNR orders, among patients with solid tumors (ST) who died at our institution. Methods: We reviewed all adult patients (age>18 years) with a diagnosis of ST who died in hospital at M.D. Anderson Cancer Center from June, 2010 through March, 2011 (excluded: hematologic malignancies). Data on patients’ demographics, chemotherapy within last 30 days (excluded: hormones), inpatient DNR orders, and comorbidities were from the institution’s administrative databases. Statistical analyses were: chi-square test for association between variables; univariate and logistic regression for association of chemotherapy use with age, gender, ethnicity, comorbidities, years of disease diagnosis, and metastatic status; statistical significance is defined as P value < 0.05. Results: 357 ST patients died in hospital: median age 60 years; 41% female; 81% MST; 44% had lung, breast or colorectal cancer. Patients receiving chemotherapy within last 30 days of life: 29% with MST; 18% without metastases (p = 0.06). DNR orders: 90% with MST, versus 79% without metastases (p =0.01). By regression analyses, there were no significant factors for chemotherapy use during the last 30 days of life (age, gender, ethnicity, years from time of disease diagnosis, metastatic status, and co-morbid conditions, each p>0.05). Conclusions: Only a small portion of patients with MST received chemotherapy within the last 30 days of life, while most had DNR orders indicating an end of life discussion. We need to study further the relationship of early discussion of treatment goals to clinical outcomes and end of life planning.

Palliative Chemotherapy Near the End of Life in Oncology Patients

2018 ◽  
Vol 35 (9) ◽  
pp. 1215-1220 ◽  
Author(s):  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Age Groups ◽  
Treatment Strategies ◽  
Cancer Center ◽  
Eol Care ◽  
To Receive

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.

Characteristics of end-of-life (EOL) chemotherapy (CTx) received by patients with advanced cancers and association with EOL emergency department (ED) and intensive care unit (ICU) care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19222-e19222
Author(s):  
Cathy Zhang ◽  
Mark W. Beiter ◽  
Maria Magdalena Gonzalez ◽  
Emebet T. Gebremeskel ◽  
Gunita Kashyap ◽  
...  
Keyword(s):  
Cancer Center ◽  
Administration Route ◽  
Quality Metric ◽  
Advanced Malignancies ◽  
Different Types ◽  
Chi Squared ◽  
Median Test ◽  
Ed Visits ◽  
To Receive

e19222 Background: Use of EOL CTx is an established quality metric in patients with advanced malignancies but less is known about which types of CTx are most commonly used and association with ED and ICU utilization. We sought to describe the different types of EOL CTx and to quantify the frequency of EOL ED and ICU care associated with them. Methods: Patients in the cancer registry of an urban cancer center who died between January 1, 2018 and October 10, 2019, and ever received CTx were included. EOL CTx was defined as any CTx given within 30 days of death, while any ED visits or ICU admissions in the last 30 days of life were defined as EOL ED and ICU care, respectively. CTx was categorized by administration route (intravenous (IV), oral (PO), other), and by type (immunotherapy (IMT), non-immunotherapy biologics (NIB), other). We used Pearson’s chi-squared to measure associations between EOL CTx and EOL ED and ICU care, logistic regression to assess how CTx type modulates those associations, and Mood’s median test to compare median IMT doses between groups. Results: Among 390 eligible patients, 32% received EOL CTx, 30% EOL ED care, and 11% EOL ICU care. Most received IV CTx (78%), and 10% received IMT. Median age at diagnosis was 69 years (interquartile range (IQR) 62 - 77), and median days from diagnosis to death was 390 (IQR 185 - 665). Most common malignancies were pancreatobiliary (40%), other gastrointestinal (15%), lung (13%) and hematologic (6%). Patients treated with EOL CTx were significantly more likely to receive IMT (p = 0.03). Receipt of any EOL CTx was significantly associated with EOL ED care (p < 0.0001) and EOL ICU care (p < 0.0001). Subgroup analyses showed significant modulatory effect of IMT on association of EOL CTx with EOL ED care (b = -0.89, p = 0.046), but was not significant for ICU care (b = -0.67, p = 0.29). Median doses of IMT was 2.5 (IQR 2 - 3.8) among patients who were given EOL IMT and 4 doses (IQR 2 - 6) in those that discontinued IMT before EOL (p = 0.06). Conclusions: EOL CTx is associated with significantly increased rates of EOL ED and ICU care, which may indicate poorer quality of life. While rates of use of other CTx modalities did not significantly differ at EOL, patients were more likely to receive IMT within 30 days of death, which could be due to the belief that IMT is more tolerable or more effective than other CTx modalities at EOL. IMT at EOL is associated with a reduced risk of EOL ED care, but not ICU care. Further research on strategies to reduce EOL CTx and appropriateness of IMT at EOL is warranted.

scholarly journals Chemotherapy and Targeted Therapy Near the end of life Affects Aggressiveness of Palliative Care

2020 ◽  
Author(s):  
Wen-Wu Cheng ◽  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu
Keyword(s):  
Targeted Therapy ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Cancer Center ◽  
Integrated Therapy ◽  
The Difference ◽  
To Receive

Abstract Background: In patients with advanced cancer, considering the increased application of targeted therapy and immunotherapies, we explored the difference between indicators of chemotherapy and targeted therapy in the last month of life.Methods: Electronic medical data of patients who died from metastatic cancer and received targeted therapy and palliative chemotherapy from April 2007 to December 2018 at the Department of Integrated Therapy, Fudan University Shanghai Cancer Center were analyzed retrospectively. To determine those variables that were judged to be independent predictors of the use of palliative chemotherapy and targeted therapy, and the differences between them, univariate and multivariate analyses were used.Results: Of the 585 patients included in the study, 87 (14.9%) received palliative chemotherapy and 125 (21.3%) underwent targeted therapy during the last month. Patients who received continued chemotherapy within the last month were subjected to more intensive treatment (admitted to an intensive care unit (ICU) in the last month of life (OR, 2.33; CI [1.91–2.92], P < 0.001), and received cardiopulmonary resuscitation(OR, 4.18; CI [2.91–5.40],P < 0.001)), than those who did not. Analysis of subgroups showed that the lung cancer was independently associated with targeted therapy, and admission to an ICU was independently associated with palliative chemotherapy.Conclusions: Younger patients without complications and with better performance status were more likely to receive chemotherapy. Lower rates of cardiopulmonary resuscitation and admission to ICU correlated with receipt of targeted therapy at the end of life compared with those who received chemotherapy in the last 30 days.

End-of-Life Decision-Making in Canada: The Report by the Royal Society of Canada Expert Panel on End-of-Life Decision-Making

2011 ◽  
Author(s):  
Udo Schuklenk ◽  
Johannes J. M. van Delden ◽  
Jocelyn Downie ◽  
Sheila McLean ◽  
Ross Upshur ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Royal Society ◽  
Expert Panel ◽  
End Of Life Decision ◽  
Life Decision

Planning for End of Life

2021 ◽  
pp. 104990912110141
Author(s):  
Natasha Ansari ◽  
Eric Johnson ◽  
Jennifer A. Sinnott ◽  
Sikandar Ansari
Keyword(s):  
End Of Life ◽  
Treatment Options ◽  
Stage Iv ◽  
P Value ◽  
Life Planning ◽  
Number Of Patients ◽  
End Of Life Planning ◽  
The Difference ◽  
Alternative Medications ◽  
Patient’S Perception

Background: Oncology provider discussions of treatment options, outcomes of treatment, and end of life planning are essential to care for patients with advanced malignancies. Studies have shown that despite this, many patients do not have adequate care planning, including end of life planning. It is thought that the accessibility of information outside of clinical encounters and individual factors and/or beliefs may influence the patient’s perception of disease. Aims: The objective of this study was to evaluate if patient understanding of treatment goals matched the provider and if there were areas of discrepancy. If a discrepancy was found, the survey inquired further into more specific aspects. Methods: A questionnaire-based survey was performed at a cancer hospital outpatient clinic. 100 consecutive and consenting patients who had stage IV non-curable lung, gastrointestinal (GI), or other cancer were included in the study. Patients must have had at least 2 visits with their oncologist. Results: 40 patients reported their disease might be curable and 60 reported their disease was not curable. Patients who reported their disease was not curable were more likely to be 65 years or older (P-value: 0.055). They were more likely to report that their doctor discussed the possibility of their cancer getting worse (78.3% VS 55%; P-value 0.024), that their doctor discussed end of life plans (58.3% VS 30%; P- value: 0.01), and that they had appointed a health care decision-maker (86.7% VS 62.5%; P-value: 0.01). 65% of patients who thought their disease might be curable reported that their doctor said it might be curable, compared with only 6.7% of patients who thought their disease was not curable (p < 0.001). Or, equivalently, 35% of patients who thought their disease might be curable reported that their doctor’s opinion was that it was not curable, compared with 93% of patients who thought their disease was not curable (p < 0.001). Patients who had lung cancer were more likely to believe their cancer was not curable than patients with gastrointestinal or other cancer, though the difference was not statistically significant (p = 0.165). Patients who said their disease might be curable selected as possible reasons that a miracle (50%) or alternative medicine (66.7%) would get rid of the cancer, or said their family wanted them to believe the cancer would go away (16.7%) or that another doctor said it would (4.2%). Patients who said their disease might be curable said they did so due to alternative medications, another doctor, or their family. Restricting to the 70 patients who reported their doctors telling them their disease was not curable, 20% of them still said that they personally felt their disease might be curable. Patients below 65 years of age were more likely to disagree with the doctor in this case (P-value: 0.047). Conclusion: This survey of patients diagnosed with stage IV cancer shows that a significant number of patients had misunderstandings of the treatment and curability of their disease. Findings suggest that a notable proportion kept these beliefs even after being told by treating physicians that their disease is not curable.

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