Chemotherapy Given Near the End of Life by Community Oncologists for Advanced Non-Small Cell Lung Cancer

Abstract

Purpose. To characterize the chemotherapy given near the end of life to advanced non-small cell lung cancer (NSCLC) patients treated in the community oncology setting using a medical records database. Results. We report data from 10 community practices including 417 patients treated for advanced NSCLC in 2000-2003. The mean age was 67 years (median, 62 years) and 54% were male. Forty percent of patients were >69 years of age and 35% had an Eastern Cooperative Oncology Group performance status score of ≥2.First-line chemotherapy included combination therapy in 84% of patients. Second-line therapy was given to 56% of patients. Twenty-six percent of patients received third-line therapy, while 10% received fourth-line therapy and 5% received fifth-line therapy or greater. Patients received a mean of 6.1 cycles of chemotherapy. For patients receiving chemotherapy at the time of death, the mean line of therapy being given was second line. Chemotherapy was given within 1 month and 2 weeks of death to 43% and 20% of patients, respectively.Conclusion. The availability of new chemotherapeutic agents has caused a subsequent increase in the length of time patients are receiving chemotherapy with advanced NSCLC. This would suggest an increased use of chemotherapy near the end of life, which was identified in this study.

Knowledge, Attitudes, and Practice Behaviors of Oncology Advanced Practice Nurses Regarding Advanced Care Planning for Patients With Cancer

“…The current study's respondents also reported that the aggressive treatment received by patients at end of life in their practice settings was quite common, consistent with current literature (Braga et al, 2005;Earle et al, 2004Earle et al, , 2008Murillo & Koeller, 2006). Similiarly, respondents stated that most patients with advanced cancer in their practice did not have advanced care planning discussions with clinicians, and many continued to receive active chemotherapy during last month of life with only a minority using hospice care.…”

Treatment results including more than third-line chemotherapy for patients with advanced non-small cell lung cancer

“…of chemotherapy cycles 7 15 In this study, the subgroup analysis showed that 49 patients were treated with less than second-line chemotherapy and 33 patients (40.2%) were treated with more than third-line chemotherapy. this result is similar to that of Murillo and Koeller, who also reported that 41% patients received more than third-line chemotherapy (9).…”

Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

“…They have also undergone testing in other health care settings and in other countries. 7,8 One reason for this interest is that they have the relatively unique feature of assessing overuse. Oncologists have traditionally focused on underuse (surgery, adjuvant chemotherapy or radiation) as the source of most quality problems, with little attention to the possibility that overuse could result in poor quality care.…”