Can Anti-Infective Drugs Improve the Infection-Related Symptoms of Patients with Cancer during the Terminal Stages of Their Lives?

Nakagawa, Sari; Toya, Yoshie; Okamoto, Yoshiaki; Tsuneto, Satoru; Goya, Sho; Tanimukai, Hitoshi; Matsuda, Yoichi; Ohno, Yumiko; Eto, Hiroshi; Tsugane, Mamiko; Takagi, Tatsuya; Uejima, Etsuko

doi:10.1089/jpm.2009.0336

Cited by 37 publications

(34 citation statements)

References 12 publications

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“…demonstrated that antibiotic therapy improved patients’ QOL, showing effectiveness for terminally ill patients. [6] We found that 2 of 30 cases who received antibiotic therapy (one with UTI, and the other with cholangitis) had improved symptoms related to infections as described above. In contrast, in the remaining 28 cases, blood cultures could not contribute to the treatment because all of them were on palliative sedation or were unconscious due to CO 2 narcosis.…”

Section: Discussionmentioning

confidence: 71%

“…Some previously documented that antibiotic therapy was effective for terminally ill cancer patients who were symptomatic and clearly conscious in order to improve symptoms related to infection and their quality of life (QOL). [46–9] On the other hand, it is reported that antibiotic therapy is less effective among patients with respiratory tract infections than among those with urinary tract infections (UTIs). [7–9] It is very common that dexamethasone (DEX), palliative sedation, or both are given to terminally ill patients with lung cancer because they mostly present with severe dyspnea.…”

Section: Introductionmentioning

confidence: 99%

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Should blood cultures be performed in terminally Ill cancer patients?

Asai

Aoshima

Ohkuni

et al. 2012

Indian J Palliat Care

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Background:No evidence-based guidelines or protocols to treat the infection-related symptoms in cancer patients with terminal stages have been established.Materials and Methods:We retrospectively analyzed all the patients with terminal stage cancer who died between April 2009 and March 2010. The patients’ background, the prevalence of infection and clinical outcomes, pathogens isolated, antibiotics used, and whether blood cultures and some of examinations were performed or not were evaluated.Results:A total of 62 (44 males and 18 females) patients were included in this study. The median age was 73 years (35–98 years). The most common cancer was that of the lung (n =59, 95.2%). A total of 32 patients were diagnosed with the following infections: Infection of respiratory tract in 27 (84.4%), of urinary tract in 4 (12.5%), and cholangitis in 1 (3.1%). Two cases (6.3%) had pneumonia complicated with urinary tract infection. Blood cultures and antibiotic therapies were performed in 28 and 30 cases, respectively. Four (14.3%) positive cultures were isolated from the blood obtained from 28 individual patients. As for clinical course, 3 (10%) of them experienced improved symptoms after antibiotic therapy. Twenty-seven (90%) patients were not confirmed as having any symptom improvement.Conclusions:Blood cultures and antibiotic therapy were limited, and might not be effective in terminally ill cancer patients with lung cancer. We suggest that administering an antibiotic therapy without performing a blood culture would be one of choices in those with respiratory tract infections if patients’ life expectancy is short.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Should blood cultures be performed in terminally Ill cancer patients?

Asai

Aoshima

Ohkuni

et al. 2012

Indian J Palliat Care

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“…23 In cancer patients receiving hospice care, antibiotics controlled symptoms in half of patients with a respiratory tract infection, 25 and in the last week of life of cancer patients with variable infections, it was 9%. 26 In other work, death with an infection (95% antibiotic-treated) in hospice patients was more frequently peaceful than death without infection (86% versus 52%; P < .001; the reported nonsignificant P value should be erroneous). 27 Death from infection is therefore not necessarily related to suffering, and effects of antibiotics on comfort need further study.…”

Section: Discussionmentioning

confidence: 88%

Antibiotics and Mortality in Patients with Lower Respiratory Infection and Advanced Dementia

Steen

Lane

Kowall

et al. 2012

Journal of the American Medical Directors Association

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Objectives: To describe long-term mortality rate and to assess associations between mortality rate and antibiotic treatment of lower respiratory infection in patients with advanced dementia; antibiotic treatment allocation was independent of mortality risk—leaving less room for biased associations than in previous multicenter observational studies. Design: Prospective study (2004–2009). Multilevel Cox proportional hazard analyses with adjustment for mortality risk were used to assess associations between antibiotics and mortality using time-dependent covariates. Setting: A US Department of Veterans Affairs nursing home. Participants: Ninety-four residents with advanced dementia who developed 109 episodes. Measurements: Survival, treatment, mortality risk, illness severity, fluid intake, and several other patient characteristics. Results: Ten-day mortality was 48%, and 6-month mortality was 74%. Antibiotics were used in 77% of episodes. Overall, antibiotics were not associated with mortality rate (Hazard Ratio [HR] 0.70, Confidence Interval [CI] 0.38–1.30); however, antibiotics were associated with reduced 10-day mortality rate (HR 0.51, CI, 0.30–0.87; rate after 10 days: 1.5, CI 0.42–5.2). Benefit from antibiotics was less likely with inadequate fluid intake, and when experiencing the first episode. Conclusion: In our sample of male nursing home residents with advanced dementia and lower respiratory infection, mortality was substantial despite antibiotic treatment. Antibiotics prolonged life but in many cases only for several days. Treatment decisions should take into account that antibiotics may delay death but may also prolong the dying process, indicating a need for accurate prediction of mortality and study of characteristics that may alter effectiveness of antibiotics.

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“…Medicare and most commercial hospice benefits provide reimbursement at a predetermined per diem rate for all hospice care, and as such, hospice providers do not have an incentive to document an infectious indication for antibiotic reimbursement. However, previous research also has suggested that, aside from UTIs, treatment of known or suspected infections often does not improve symptoms among hospice patients (3, 7, 8, 14). Additional research with better documentation of therapeutic rationale and symptom outcomes would improve current understanding of why antibiotics are prescribed in the last week of hospice care and whether or not they are effective.…”

Section: Discussionmentioning

confidence: 97%

A Nationwide Analysis of Antibiotic Use in Hospice Care in the Final Week of Life

Albrecht

McGregor

Fromme

et al. 2013

Journal of Pain and Symptom Management

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Context Antibiotic prescribing in hospice patients is complicated by the focus on palliative rather than curative care and concerns regarding increasing antibiotic resistance. Objectives To estimate antibiotic use in a national sample of hospice patients and identify facility and patient characteristics associated with antibiotic use in this population. Methods This was an analysis of data from the 2007 National Home and Hospice Care Survey, a nationally representative sample of U.S. hospice agencies. We included data from 3884 patients who died in hospice care. The primary outcome measure was prevalence of antibiotic use in the last seven days of life. Diagnoses, including potential infectious indications for antibiotic use, were defined using International Classification of Diseases, Ninth Revision (ICD-9) codes. Chi-square tests and t-tests were used to quantify associations of patient and facility characteristics with antibiotic use. Results During the last seven days of life, 27% (95% confidence interval [CI] 24%, 30%) of patients received at least one antibiotic and 1.3% (95% CI 0.7%, 2.0%) received three or more antibiotics. Among patients who received at least one antibiotic, 15% (95% CI 10%, 20%) had a documented infectious diagnosis, compared with 9% (95% CI 7%, 11%) who had an infectious diagnosis but received no antibiotics. Conclusion In this nationally representative sample, 27% of hospice patients received an antibiotic during the last seven days of life, most without a documented infectious diagnosis. Further research is needed to elucidate the role of antibiotics in this patient population to maintain palliative care goals while reducing unnecessary antibiotic use.

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Can Anti-Infective Drugs Improve the Infection-Related Symptoms of Patients with Cancer during the Terminal Stages of Their Lives?

Cited by 37 publications

References 12 publications

Should blood cultures be performed in terminally Ill cancer patients?

Should blood cultures be performed in terminally Ill cancer patients?

Antibiotics and Mortality in Patients with Lower Respiratory Infection and Advanced Dementia

A Nationwide Analysis of Antibiotic Use in Hospice Care in the Final Week of Life

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