Chemotherapy at the end of life: Do we know when to stop?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24005-e24005
Author(s):  
Renana Barak ◽  
Einav Zagagi Yohay ◽  
Barliz Waissengrin ◽  
Ido Wolf
Keyword(s):  
End Of Life ◽  
Disease Duration ◽  
Performance Status ◽  
Poor Quality ◽  
Palliative Intent ◽  
Care Services ◽  
Palliative Care Services ◽  
Eol Care ◽  
Oncologic Treatment

e24005 Background: Aggressive end-of-life (EOL) care in cancer patients, especially the administration of chemotherapy, is considered a poor-quality measure, that may divert the treatment course from its' main palliative intent. Decisions taken at EOL are more than evidence-based and often rely on cultural and personal prospects. The universal and free Israeli health care system enables the administration of active treatment without financial or regulatory barriers, even at EOL. Two major advancements in recent years were the implementation of national at-home palliative care services and the approval of targeted and immunotherapies for advanced cancers. We hypothesized that these changes will reduce the use of chemotherapy at EOL. Methods: We sampled consecutive patients treated at a tertiary oncology center who died of advanced cancers between January 2019 to August 2020, and examined the administration of oncologic treatments near EOL. Results: A total of 294 patients were included. Their median age was 67 and 147 were men, 64% (189) of the patients received oncologic treatment during the last month before death, chemotherapy was administered in nearly two-thirds of the cases, 64% (121), followed by immunotherapy (21%, 40), targeted therapy (10%, 19) and a clinical trial (5%, 9). Neither age (P = 0.4), gender (P = 0.9), performance status (P = 0.8), disease duration (P = 0.5), and type of previous oncologic treatment (P = 0.3) were associated with aggressive EOL care. Conclusions: Our data demonstrate that in the absence of any regulatory or financial limitations, an aggressive EOL care may be administered to the majority of patients, regardless of age, performance status or disease duration. Despite increasing use of immunotherapy and targeted therapies and despite its’ toxicity profile and low beneficial effect at this stage, chemotherapy remained the most commonly used type of treatment. These data call for the implementation of educational measures and appropriate universal guidelines, aiming at improving quality of treatment at the EOL, focusing on quality of life rather than the elusive potential of extending life.

End-of-life cancer care: Health service delivery in the last 12 months of life in Calgary, Alberta, Canada.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 171-171
Author(s):  
Marc Kerba ◽  
Ayn Sinnarajah ◽  
M Sarah Rose ◽  
Lynn Nicholson ◽  
Barbara Wheler ◽  
...  
Keyword(s):  
Palliative Care ◽  
Service Delivery ◽  
End Of Life ◽  
Disease Duration ◽  
Multivariate Regression Analysis ◽  
Health Service Delivery ◽  
Care Services ◽  
Palliative Care Services ◽  
Eol Care ◽  
To Receive

171 Background: In Calgary, Alberta, the Calgary Zone Palliative Care Collaborative (CZPCC) undertook a study to examine the current state of cancer and palliative services and to recommend steps to address gaps in service delivery. We hypothesized that early access to palliative care services would reduce utilization of active cancer treatments and services for individuals nearing the end of life. Our study objectives were to determine the utilization and timing of acute, palliative and oncology-related services in Calgary. Methods: This retrospective study examined cancer registry and administrative data for patients > 18 years, who died in 2012. Measures of aggressive end of life care (EOL) were also collected. A combination of descriptive statistics, tests of association and multivariate regression analysis were conducted. Results: N = 1909 died of cancer in 2012: median age 73 years (IQR: 62-82 years) and median disease duration 364 days (IQR: 92-1114 days). 40.6% of patients received systemic treatment in last 12 months of life. 29.9% received radiotherapy and 13.0% received psychosocial/spiritual care. Palliative care contact was 80.7%, inclusive of 20.6% who had an intensive palliative care unit admission. 5.2% had EOL chemotherapy and 3.8% received EOL radiotherapy. Up to 10.4% of patients had one or more hospital admission. There was no significant effect of age on those who received aggressive EOL care. Men had an increased probability to receive aggressive EOL care (p = 0.015). Tumor group was also associated with receiving aggressive EOL (p < 0.001), with the highest utilization in Head and Neck and hematological malignancies. In patients with a disease duration of > 4 months those who received palliative care at least 2-3 months prior to death were less likely to receive aggressive EOL care (P < 0.001). Patients whose disease duration was < 1 month were less likely to receive aggressive EOL care if they received palliative care services (p = 0.02). Conclusions: The provision of palliative care services at the end of life is most needed among men and certain tumor groups who are the highest users of aggressive EOL care.

scholarly journals Trends in the Aggressiveness of End-of-Life Cancer Care in the State of Qatar

2016 ◽  
Vol 2 (2) ◽  
pp. 68-75 ◽  
Author(s):  
Azza A. Hassan ◽  
Hassan Mohsen ◽  
Ayman A. Allam ◽  
Pascale Haddad
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Cancer Care ◽  
The State ◽  
Care Services ◽  
Palliative Care Services ◽  
Excellent Care ◽  
Eol Care

Purpose Quality of end-of-life (EOL) care is a key component of excellence in cancer care, and monitoring indicators for quality of EOL cancer care is crucial to providing excellent care. The aim of the current study is to describe the relative aggressiveness of EOL cancer care in the state of Qatar and to compare it with international figures. Methods We analyzed all deaths from cancer in Qatar between January 1, 2009 and December 31, 2013. A total of 784 eligible patients were studied to assess aggressiveness of cancer care at EOL. Results The average number of intensive care unit admissions per person decreased from 0.44 to 0.22 (P < .001) over the period of study. In addition, patients spent fewer days in the intensive care unit (2.79 to 1.82 days; P = .006) and made fewer visits to the emergency department (1.00 to 0.52 visits; P < .001) in the last 30 days of life. Fewer patients had at least one aggressive treatment measure at EOL during the 5-year period (82.3% to 71.0%; P = .038). The mean composite score for aggressiveness of EOL care decreased from 2.24 to 1.92 (P < .01). Conclusion The aggressiveness of EOL cancer care has significantly decreased over time in Qatar; however, despite this decrease, the rate is still higher than that reported internationally. The integration of community palliative care services in Qatar may further decrease the aggressiveness of cancer care at EOL.

Hospitalization burden and end-of-life (EOL) care in elderly patients with glioblastoma (GBM).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 31-31
Author(s):  
Laura Donovan ◽  
Donna Buono ◽  
Melissa Kate Accordino ◽  
Jason Dennis Wright ◽  
Andrew B. Lassman ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Palliative Care ◽  
Elderly Patients ◽  
Marital Status ◽  
End Of Life ◽  
Remaining Life ◽  
Care Services ◽  
Palliative Care Services ◽  
Race Ethnicity ◽  
Eol Care

31 Background: GBM is associated with a poor prognosis and early death in elderly patients. Prior studies have demonstrated a high burden of hospitalization in this population. We sought to evaluate and examine trends in hospitalizations and EOL care in GBM survivors. Methods: Using SEER-Medicare linked data, we performed a retrospective observational cohort study of patients aged ≥ 65 years diagnosed with GBM from 2005-2017 who lived at least 6 months from the time of diagnosis. Aggressive EOL care was defined as: chemotherapy or radiotherapy within 14 days of death (DOD), surgery within 30 DOD, > 1 emergency department visit, ≥ 1 hospitalization or intensive care unit admission within 30 DOD; in-hospital death; or hospice enrollment ≤ 3 DOD. We evaluated age, race, ethnicity, marital status, gender, socioeconomic status, comorbidities, prior treatment and percentage of time hospitalized. Multivariable logistic regression was performed to determine factors associated with aggressive end of life care. Results: Of 5827 patients, 2269 (38.9%) survived at least 6 months. Among these, 1106 (48.7%) survived 6-12 months, 558 (24.6%) survived 12-18 months, and 605 (26.7%) survived > 18 months. Patients who survived 6-12 months had the highest burden of hospitalization and spent a median of 10.6% of their remaining life in the hospital compared to those surviving 12-18 months (5.4%) and > 18 months (3%) (P < 0.001). 10.1% of the cohort had claims for palliative care services; 49.8% of initial palliative care consults occurred in the last 30 days of life. Hospice claims existed in 83% with a median length of stay 33 days (IQR 12, 79 days). 30.1% of subjects received aggressive EOL care. Receiving chemo at any time (OR 1.510, 95% CI 1.221-1.867) and spending ≥ 20% of life in the hospital after diagnosis (OR 3.331, 95% CI 2.567-4.324) were associated with aggressive EOL care. Women (OR 0.759, 95% CI 0.624-0.922), patients with higher socioeconomic status (OR 0.533, 95% CI 0.342-0.829), and those diagnosed ≥ age 80 (OR 0.723, 95% CI 0.528-0.991) were less likely to receive aggressive EOL care. Race, ethnicity, marital status, and extent of initial resection were not associated with aggressive EOL care. Conclusions: A minority of elderly patients with GBM in the SEER-Medicare database survived ≥ 6 months; hospitalizations were common and patients spent a significant proportion of their remaining life hospitalized. Although hospice utilization was high in this cohort, 30% of patients received aggressive EOL care. Despite the aggressive nature of GBM, few patients had palliative care consults during their illness. Increased utilization of palliative care services may help reduce hospitalization burden and aggressive EOL care in this population.

Call the Rezadora: Aiding Latino Families at the End of Life

2021 ◽  
pp. 154041532110289
Author(s):  
Kim L. Larson ◽  
Graziella D. Jewell ◽  
Maria Fernanda Maldonado ◽  
Morgan E. Braxton ◽  
Lee Ann Johnson
Keyword(s):  
End Of Life ◽  
Single Case ◽  
The United States ◽  
Latino Families ◽  
Holistic View ◽  
Serious Illness ◽  
Care Services ◽  
Palliative Care Teams ◽  
Eol Care

Introduction: The rezadora, a lay spiritual leader, provides support to Latino families as they provide end-of-life (EOL) care for loved ones. The purpose of this study was to learn about the work of the rezadora in Guatemala as a resource for Latinos with serious illness in the United States. Methods: An ethnographic exploratory case study was conducted during summer 2018 in rural Guatemala. We interviewed three rezadoras who resided in two villages. The study yielded two cases, the single case and the paired case, which allowed for a holistic view of how the rezadora serves the community. Results: Content and thematic analysis led to two themes: Essence of being called and Power of prayerful song. Essence of being called was represented by the prominence of the rezadora and their perpetual faith work. Power of prayerful song was characterized through the mission, customs, and the presence of the rezadora. A good death was aided by the rezadora in this context. Conclusions: As the Latino population ages in place, the need for palliative and EOL care services will increase. Lay spiritual leaders could enhance the palliative care teams in these communities and improve the quality of life for Latinos with serious illness.

scholarly journals The Association Between Home Palliative Care Services and Quality of End-of-Life Care Indicators in the Province of Québec

2015 ◽  
Vol 50 (1) ◽  
pp. 48-58 ◽  
Author(s):  
Bruno Gagnon ◽  
Lyne Nadeau ◽  
Susan Scott ◽  
Serge Dumont ◽  
Neil MacDonald ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Care Services ◽  
Palliative Care Services

Interpreting in palliative care: A systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited English proficiency.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 123-123 ◽  
Author(s):  
Milagros Silva ◽  
Margaux Genoff ◽  
Alexandra Zaballa ◽  
Stacy Marie Stabler ◽  
Francesca Gany ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
Limited English Proficiency ◽  
Goals Of Care ◽  
Care Services ◽  
Palliative Care Services ◽  
The Impact

123 Background: According to the 2011 U.S. Census 60% of people living in the U.S. speak a language other than English at home, and of these approximately 40% have limited English proficiency (LEP). Language barriers can affect the health outcomes of LEP patients and the use of trained interpreters can improve patient-physician communication. Since effective communication is the cornerstone of delivering adequate palliative care, a systematic review was conducted to determine the impact of interpreters on the delivery of palliative care services to LEP patients with cancer. Methods: We conducted a systematic review of the literature search in all available languages of 6 databases from 1966 and 2013. Studies evaluated interpreter interventions for LEP patients receiving palliative care services. Of 38 references, 11 articles were found by multiple reviewers to meet inclusion criteria. Data were collected on the study design, size, comparison groups, outcomes, and interpreter characteristics. Results: A total of 6 qualitative and 5 quantitative studies assessed the use of interpreters. All studies found that the quality of care provided to LEP patients receiving palliative services is affected by communication. Most studies showed that when no trained interpreters were used, LEP patients and families had inadequate understanding about their diagnosis or prognosis during goals of care conversations, and worse symptom management at end of life including pain and anxiety. Half of the studies concluded that trained interpreters are not utilized adequately and several suggested that pre-meetings between clinicians and interpreters are important to discuss topics and terminology to be used during goals of care conversations. Conclusions: Published studies show worse outcomes during end of life care and goals of care discussions when trained interpreters are not used. Moreover, trained interpreters are not being used appropriately in the field. More clinically relevant studies are needed to improve the quality of care provided to LEP patients and families receiving palliative services.

scholarly journals Review of End-of-Life Care and Supportive Care during Disease Course in Elderly Patients with Multiple Myeloma

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4731-4731
Author(s):  
Sunyoung Jeong ◽  
Seug Yun Yoon ◽  
Min Young Lee ◽  
Kyoung Ha Kim ◽  
Nam Su Lee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Myeloma ◽  
Overall Survival ◽  
Supportive Care ◽  
End Of Life ◽  
Performance Status ◽  
Age At Diagnosis ◽  
Disease Course ◽  
Eol Care

Abstract Background Multiple myeloma (MM) is a plasma cell malignancy of which the median age at diagnosis is 70 years old. The novel agents had contributed significant improvement in the overall survival of MM. However, there is a disparity in survival between young and old patients, and early mortality is high in patients older than 70. Therefore, before making a treatment plan for elderly MM patients, it is crucial to consider both quality of life and even end-of-life (EOL) care. This study evaluated EOL characteristics and real-world supportive care in elderly MM patients. Methods We retrospectively reviewed medical records of patients diagnosed with MM at an age older than 70 between January 2011 and April 2021. We identified baseline characteristics, symptom burdens, factors associated with hospitalizations during the disease course, and several indicators of EOL; place of death, length of hospitalization, cause of death, chief complaints, agreement of "do-not-resuscitate (DNR)", other aggressive and less aggressive interventions in their last hospitalization. Result A total of 52 patients were included. The median age at diagnosis is 76 years old. 12 (23.08%) patients showed initial Eastern cooperative oncology group (ECOG) performance status 3 or 4. 30 (57.69%) patients had hypertension, 18 (34.62%) had diabetes, and 8 (15.38%) had chronic lung disease; asthma, COPD, and bronchiectasis. 3 (5.77%) patients had initial International staging system (ISS) stage 1 disease, 16 (30.77%) had 2, and 29 (55.77%) had 3. Only 2 (3.85) patients never received chemotherapy; one of them showed initial ECOG 3, and the other was unknown. The median overall survival was 16.69 months. 27 (51.92%) patients visited the emergency department during their disease course at least once, and 19 (36.54%) were admitted intensive care unit more than once. Only 4 (7.59%) patients were never admitted hospital during their disease course except for chemotherapy. The mean number of hospitalization was 3.23, and the reason for 41.67% of hospitalization was to control myeloma-related symptoms; general weakness, acute kidney injury, pain, fracture, cord compression, and anemia. The rate of hospitalization day after diagnosis was 9.85%. The EOL characteristics of 24 (46.15%) deceased at the hospital were analyzed. An average hospitalization length was 41.96 days. Other EOL characteristics are detailed in table 1. Conclusion Elderly MM patients spent almost 10% of their disease duration at the hospital to control disease-related symptoms. It might explain why elderly MM patients received aggressive therapy despite their age and poor performance status. To enhance their quality of life, we need to focus more on supportive care and make a decision for chemotherapy carefully. Furthermore, for EOL care, discussion for performing an aggressive intervention with patients should be encouraged. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Analytical review of the demand and satisfaction of the population with inhome palliative care services for cancer patients provided by mobile teams in Almatу

2020 ◽  
Vol 56 (2) ◽  
pp. 4-8
Author(s):  
T. N. Ansatbaeva ◽  
D. R. Kaidarova ◽  
G. Zh. Kunirova ◽  
N. А. Izmagambetov
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Malignant Neoplasms ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Services ◽  
Palliative Care Services ◽  
Analytical Review

Relevance: Patients with advanced malignant neoplasms require constant monitoring and care. Mobile palliative care (PC) is one of the modern humanistic methods of supporting terminal cancer patients, as well as their relatives. The purpose of this study was to analyze the demand and satisfaction of the population with in-home PC services for cancer patients provided by mobile teams in Almaty. Results: According to WHO, the number of people who need PС services at the end of life is 20.4 million, of whom 94% are adults (69% are over 60 years, 25% are at the age of 15 to 59), and 6% are children. 34% of patients dying from cancer need PC services at the end of life. 80% of people in need of PC services live in lower-middle-income countries. At the end of 2018, the total number of palliative beds deployed in the Republic of Kazakhstan amounted to 415 (vs. 373 in 2017). Conclusion: Given the practical relevance and topicality, there is an urgent need to develop evidence-based recommendations for optimizing the provision of PC services, as well as improving the quality of life of cancer patients

What is palliative care?

2020 ◽  
Vol 14 (1) ◽  
pp. 19-26
Author(s):  
Francis Odukwe ◽  
Francis Ezeh
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
World Health Organisation ◽  
World Health ◽  
Care Services ◽  
Care Specialist ◽  
The World ◽  
Palliative Care Services ◽  
Serious Injuries

In 1990, the World Health Organisation (WHO) recognised palliative care as a distinct specialty dedicated to relieving suffering and improving quality of life for patients with life-limiting illnesses or serious injuries. Fourteen years later, the WHO in its publication ‘ Global Atlas of Palliative Care at the End of Life’, projected that, ‘each year in the world, around 377 per 100,000 of the adult (over 15 years of age) population and 63 per 100,000 of the child population (under 15 years of age) will require “palliative care at the end of life’. This article will discuss what constitutes palliative care, the different elements of palliative care, the approaches to palliative care, specialist palliative care services, end of life care and where GPs fit into this area. We will also be sharing tips on providing palliative care as a GP and for GP trainees.

Sign in / Sign up

Export Citation Format

Share Document