When should anti-cancer treatment be ended? Why and when to discontinue palliative chemotherapy.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 41-41
Author(s):  
Yuurin Kondo ◽  
Maria Michiko Nakajima ◽  
Go Nakajima ◽  
Kazuhiko Hayashi
Keyword(s):  
Life Expectancy ◽  
End Of Life ◽  
Palliative Chemotherapy ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Incurable Cancer ◽  
Clear Explanation ◽  
Anti Cancer ◽  
Practice Methods

41 Background: Currently, palliative chemotherapy (PC) near the end of life is frequently discussed. It is important to know when it is appropriate to end PC to maintain the best quality of life. The criteria for discontinuation of anti-cancer therapy are often “exacerbation of patient’s condition,” “problems with toxicity,” or “patient refusal.” However, there is no clear agreement regarding when to end PC. Ending treatment is one of the most difficult decisions for oncologists. The purpose of this study was to determine clear reasons for the discontinuation of PC and to gain an understanding of the current situation regarding explanation of prognosis in clinical practice. Methods: This retrospective study included 144 patients with incurable cancer who had received PC and died between January 2014 and November 2016. We examined the reasons for discontinuation of PC and whether patients had completed end-of-life discussions, including a discussion of life expectancy, when their PC was terminated. Results: Causes of discontinuation of PC were as follows: 8.3% patient’s desire, progressive disease (PD) in 48.5%, poor performance status (PS) in 20.1%, and toxicity in 17.4%. In patients who chose to end anticancer therapy voluntarily, all patients received a clear explanation of their prognosis, including life expectancy. Among 67 patients with PD, 45 (67.1%) received information regarding their prognosis; 17 of 29 patients (58.6%) with poor PS received similar information. Among patients who ended PC due to toxicity, only 8 of 25 patients (32%) completed end-of-life discussions, including a discussion of life expectancy. In addition, death within 1 month from the discontinuation of PC occurred in 0 cases where treatment was discontinued due to patient’s desire, 10 cases (15%) due to PD, 10 cases (34.4%) due to PS, and 7 cases (28%) due to toxicity. Conclusions: This study shows that patients who discontinued treatment due to poor PS or toxicity had a shorter interval between the final PC and death. Moreover, it indicated that the details of the end-of-life discussion might be influenced by the reason for discontinuation of PC, including or excluding a discussion of life expectancy.

Utilizing Eastern Cooperative Oncology Group (ECOG) performance status scores to prevent harm with chemotherapy at the end of life.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 146-146
Author(s):  
Eve Newhart ◽  
Beth Karlan ◽  
Rita Shane ◽  
Vipul Patel ◽  
Bradley T. Rosen ◽  
...  
Keyword(s):  
End Of Life ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Cancer Treatments ◽  
Ecog Performance Status ◽  
Number Of Patients ◽  
Inpatient Settings ◽  
Practice Methods

146 Background: According to ASCO’s “top five” list of non evidence-based cancer treatments and procedures, the use of chemotherapy in solid tumor patients with evidence of poor performance status is at the top of the list. The Dartmouth Atlas report revealed a significant overuse of chemotherapy at the end of life (EOL), and Cedars-Sinai was identified as an outlier with regards to this practice. Methods: Cedars-Sinai’s interdisciplinary cancer quality committee designed a new initiative to eliminate the ineffective administration of chemotherapy. Each patient’s ECOG score, entered by a nurse or physician, was used as an appropriateness screen by pharmacists before they released chemotherapy in both the outpatient and inpatient settings. If a patient did not qualify for chemotherapy based on an ECOG score of 3 or greater, the pharmacist contacted the prescribing oncologist to discuss the case. Ultimately the oncologist had the final say as to whether the patient received chemotherapy. Data was collected on ECOG scores, number of patients screened and identified as being at risk, oncologists’ responses to being notified, and whether chemotherapy was ultimately administered. Results: Available data collected on the % of orders with ECOG scores, since February of 2014 is shown in the Table. Conclusions: Data and conclusions regarding oncologists’ responses to being notified, and whether chemotherapy was ultimately administered, and harm thus prevented, is currently being compiled and will be presented at the conference. [Table: see text]

Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status

2011 ◽  
Vol 13 (6) ◽  
pp. 426-429 ◽  
Author(s):  
Alfonso Sánchez-Muñoz ◽  
Elisabeth Pérez-Ruiz ◽  
María Isabel Sáez ◽  
José Manuel Trigo ◽  
M. Mar Galindo ◽  
...  
Keyword(s):  
Palliative Chemotherapy ◽  
Performance Status ◽  
Poor Performance ◽  
Solid Tumours ◽  
Poor Performance Status ◽  
Limited Impact

Immune Checkpoint Inhibitor Use Near the End of Life Is Associated With Poor Performance Status, Lower Hospice Enrollment, and Dying in the Hospital

2019 ◽  
Vol 37 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Chad Glisch ◽  
Yuya Hagiwara ◽  
Stephanie Gilbertson-White ◽  
Yubo Gao ◽  
Laurel Lyckholm
Keyword(s):  
End Of Life ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Inhibitor Treatment

Background: Immune checkpoint inhibitors have changed the landscape of cancer care by increasing progression-free and overall survival in some patients with cancer. We evaluated use and variables contributing to immune checkpoint inhibitor treatment near the end of life. Methods: We studied 157 patients who received immune checkpoint inhibitors and died between January 2015 and December 2018. All patients had a palliative care consult any time between starting an immune checkpoint inhibitor and death. Univariate and multivariate models were used to examine variables related to immune checkpoint inhibitor use near the end of life. Results: Among 157 patients studied, 42 (27%) received a dose of immune checkpoint inhibitor in the last 30 days of life. Those who received treatment in the last 30 days of life had lower hospice enrollment (19 [45%] vs 78 [69%], P = .007) and higher rates of dying in the hospital (23 [56%] vs 33 [29%], P = .002). The percentage of patients with Eastern Cooperative Oncology Group (ECOG) ≥3 at the time of last immune checkpoint inhibitor dose was higher in the group that received immune checkpoint inhibitor treatment in the last 30 days of life (11 [26%] vs 9 [8%], P = .003). Lack of traditional chemotherapy after immune checkpoint inhibitor, ECOG ≥3, and lack of hospice enrollment were independently associated with receiving immune checkpoint inhibitor in the last 30 days of life. Conclusion: Immune checkpoint inhibitor use in the last 30 days of life is common and associated with poor performance status, lower hospice enrollment, and dying in the hospital.

Trends in checkpoint inhibitor therapy for advanced urothelial cell carcinoma (aUC) at the end of life: Insights from real-world practice.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 395-395 ◽  
Author(s):  
Ravi Bharat Parikh ◽  
Matt D. Galsky ◽  
Bishal Gyawali ◽  
Fauzia Riaz ◽  
Tara Laura Kaufmann ◽  
...  
Keyword(s):  
End Of Life ◽  
Real World ◽  
Systemic Therapy ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Poor Performance ◽  
Nonparametric Tests ◽  
Poor Performance Status ◽  
National Guidelines ◽  
Health Database

395 Background: National guidelines recommend against chemotherapy use at the end of life. Five CPIs are now approved for aUC. We hypothesized that oncologists may have a lower threshold to initiate CPI in patients (pts) at the end of life, particularly among pts with poor performance status (PS), because of the perceived favorable toxicity profile of CPI. Methods: We conducted a secular trend analysis using the Flatiron Health Database, a large real-world electronic medical record-derived dataset. We used nonparametric tests of trend (p values reported as ptrend) to evaluate quarterly proportions of pts initiating CPI, chemotherapy, or no systemic therapy within 30 and 60 days of death, among 2959 pts diagnosed with aUC from 2015 to 2017. Results: 1637 pts died during follow-up and were eligible for analysis. 278 (17.0%) and 488 (29.8%) pts initiated a new line of systemic therapy in the last 30 and 60 days of life, respectively. The quarterly proportion of CPI initiators within 60 days of death increased from 1.0% to 23% during the study period ( ptrend < 0.001), with corresponding decreases in chemotherapy initiation and no systemic therapy. After CPI approval in mid-2016, CPI initiation significantly increased among pts with Eastern Cooperative Oncology Group (ECOG) PS ≥ 2 ( ptrend = 0.02) but did not significantly change among pts with PS 0-1. Initiation of any systemic therapy at the end of life doubled (17.4% to 34.8%) over the study period, driven largely by end-of-life CPI use. Compared to chemotherapy initiators, CPI initiators had slightly worse PS (table). Conclusions: In patients with aUC, there has been a dramatic rise in CPI initiation at the end of life particularly among pts with poor PS. Existing guidelines on systemic therapy initiation near the end of life should account for the increasing use of CPI. [Table: see text]

scholarly journals Palliative chemotherapy for patient with advanced tumor and poor performance status: Are oncologists’ hopes of benefit justified?

2018 ◽  
Vol 29 ◽  
pp. viii553
Author(s):  
V.F. Vasconcellos ◽  
R.R.C.C. Bonadio ◽  
G. Avanco ◽  
M.V. Negrão ◽  
R. Riechelmann
Keyword(s):  
Palliative Chemotherapy ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Advanced Tumor

Oral talactoferrin extends survival in patients with refractory NSCLC in a randomized, placebo-controlled, phase 2 trial

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7540-7540 ◽  
Author(s):  
P. K. Parikh ◽  
Y. Wang ◽  
A. A. Ranade ◽  
A. K. Vaid ◽  
S. H. Advani ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Controlled Trial ◽  
Performance Status ◽  
Single Agent ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Phase 2 ◽  
Line Therapy ◽  
Anti Cancer ◽  
Nsclc Patients

7540 Background: Talactoferrin alfa (TLF), an immunomodulatory protein with a novel anti-cancer mechanism of action, was active preclinically and in non-small cell lung cancer (NSCLC) patients in Phase 1b studies. Randomized Phase 2 studies in NSCLC were conducted with TLF as a single agent and combined with chemotherapy. The 110-patient combination therapy study, which was previously presented (ASCO 2006, #7095), met its primary endpoint with an improved BOR over chemotherapy alone. We now present results from the placebo- controlled single agent study. Methods: 100 Stage IIIB/IV NSCLC patients who had progressed after first or second line therapy were enrolled at 10 leading Indian cancer centers, and randomized to receive best supportive care plus either oral TLF (1.5 g bid) or placebo. TLF/placebo was administered until disease progression, for up to three 14-week cycles (12 weeks on, 2 weeks off), in a centrally monitored trial. The primary endpoint was overall survival (OS) with 80% power to detect an improvement in median OS with an a=0.05. Results: All patients had previously received a 1st line platinum based regimen; 26 also received 2nd line therapy. The TLF and placebo arms enrolled 47 and 53 patients, respectively. Baseline characteristics were similar in both groups, including proportion of patients receiving 1 or 2 prior regimens. All patients were included in the Intent To Treat (ITT) analysis. The trial met its primary endpoint with a 55% increase (2.1 month; p<0.05) in median OS. TLF was well tolerated. Adverse Events (AEs) were generally mild. No drug- related SAEs were reported. Incidence of AEs and Grade 3/4 AEs was similar in both arms. Conclusion: Oral talactoferrin, a promising new anti-cancer agent, significantly improved survival in patients with refractory NSCLC in this randomized, placebo-controlled trial. TLF was well tolerated in this population. Given its favorable toxicity profile, TLF may be particularly attractive in refractory patients with poor performance status. [Table: see text] [Table: see text]

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