Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

Crawford, Gregory B.; Dzierżanowski, Tomasz; Hauser, Katherine; Larkin, Philip; Luque-Blanco, Ana; Murphy, Irene; Puchalski, Christina M.; Ripamonti, Carla

doi:10.1016/j.esmoop.2021.100225

Cited by 97 publications

(64 citation statements)

References 102 publications

(221 reference statements)

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“…A few randomised controlled trials and systematic reviews addressing different types of tumours have shown some effect of different anticancer therapies on reducing pain and improving patients’ QoL 37–42. However, this issue is largely debated as evidence is controversial or lacking, so that the guideline from the European Society for Medical Oncology (ESMO) explicitly contraindicates the use of anticancer drugs in the last weeks of life 43…”

Section: Discussionmentioning

confidence: 99%

End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy

et al. 2022

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ObjectivesInvestigating end-of-life use of anticancer drugs and of palliative care services.DesignPopulation based cohort linked to mortality registry and administrative databases.SettingEmilia-Romagna Region (Northern Italy).Participants55 625 residents who died of cancer between 2017 and 2020.Primary and secondary outcome measuresMultivariate analyses were carried out to assess the relationship between cancer drug therapy and palliative care services, and their association with factors related to tumour severity.ResultsIn the last month of life, 15.3% of study population received anticancer drugs (from 12.5% to 16.9% across the eight Local Health Authorities—LHA) and 40.2% received palliative care services (from 36.2% to 43.7%). Drug therapy was inversely associated with receiving palliative care services within the last 30 days (OR 0.92, 95% CI 0.87 to 0.97), surgery within the last 6 months (OR 0.59, 95% CI 0.52 to 0.67), aggressive tumours (OR 0.88, 95% CI 0.84 to 0.93) and increasing age (OR 0.95, 95% CI 0.95 to 0.95). Drug therapy was more likely among those with haematologic tumours (OR 2.15, 95% CI 2.00 to 2.30) and in case of hospital admissions within the last 6 months (OR 1.63, 95% CI 1.55 to 1.72). Palliative care was less likely among those with haematologic compared with other tumours (OR 0.52, 95% CI 0.49 to 0.56), in case of surgery (OR 0.44, 95% CI 0.39 to 0.49) or hospital admissions (OR 0.70, 95% CI 0.67 to 0.72) within the last 6 months, if receiving anticancer drugs during the last 30 days (OR 0.90, 95% CI 0.85 to 0.94) and for each year of increasing age (OR 0.99, 95% CI 0.99 to 0.99). Palliative care was more likely in the presence of aggressive tumours (OR 1.12, 95% CI 1.08 to 1.16).ConclusionUse of anticancer drugs and palliative care in the last month of life were inversely associated, showing variability across different LHAs. While administrative data have limits, our findings are in line with conclusions of other studies.

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Section: Discussionmentioning

confidence: 99%

End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy

et al. 2022

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“…The importance of nursing staff in terminal care and survival prediction has been highlighted and emphasized by Crawford et al in the study of cancer patients. 5 This also had been endorsed earlier in two systematic reviews. 6 , 7 …”

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confidence: 59%

Goals of Care for Patients with Severe Comorbid Illnesses Hospitalized for an Acute Deterioration

Bande¹

2022

Indian Journal of Critical Care Medicine

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“…Clinicians are encouraged to discuss these possible scenarios with patients and their families before commencing interventions, such as total parenteral nutrition. As patients approach the end of their lives, their goals of care may shift from disease management and life prolongation to symptom management and quality of life [11].…”

Section: Advanced Care Planning and Goals Of Care Conversationsmentioning

confidence: 99%

MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer

Madariaga

Lau²,

Ghoshal³

et al. 2022

Support Care Cancer

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Purpose To provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer. Methods The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced cancer and MBO that reported on the following outcomes: symptom management, bowel obstruction resolution, prognosis, overall survival, and quality of life. The review was restricted to studies published in English, but no restrictions were placed on publication year, country, and study type. As per the MASCC Guidelines Policy, the findings were synthesized to determine the levels of evidence to support each MBO intervention and, ultimately, the graded recommendations and suggestions. Results The systematic review identified 17,656 published studies and 397 selected for the guidelines. The MASCC study group developed a total of 25 evidence-based suggestions and recommendations about the management of MBO-related nausea and vomiting, bowel movements, pain, inflammation, bowel decompression, and nutrition. Expert consensus-based guidance about advanced care planning and psychosocial support is also provided. Conclusion This MASCC Guideline provides comprehensive, evidence-based recommendations about MBO management for patients with advanced cancer.

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Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines

Cited by 97 publications

References 102 publications

End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy

End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy

Goals of Care for Patients with Severe Comorbid Illnesses Hospitalized for an Acute Deterioration

MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer

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