Chemotherapy near the end of life: a retrospective single-centre analysis of patients’ charts

Abstract

BackgroundChemotherapy near the end of life is an issue frequently discussed nowadays. The concern is that chemotherapy could cause more harm than good in a palliative situation; this is even truer as the patient nears death. The objective of our study is to evaluate the aggressiveness of patient care near the end of life by determining how many cancer patients receive chemotherapy during their final weeks.MethodsIn a retrospective analysis of patient charts, we investigated whether cancer patients had been treated with chemotherapy during the last four or two weeks of life. If they had, we looked at whether treatment was ongoing or newly initiated.ResultsOut of the 119 cancer patients who died in our hospital over two years, 14 (11.7%) received chemotherapy during the last four weeks of life, nine of whom (7.6%) in the last two weeks of life. Treatment had been ongoing in six (5%) and newly initiated for eight (6.7%) within four weeks of death. Corresponding figures for the last two weeks of life were seven patients (5.9%) who continued previously prescribed treatment and two (1.7%) who were started on chemotherapy. Patients given chemotherapy during the last four weeks of life were significantly younger than those who were not (p = 0.003).ConclusionsCancer patient care in our hospital is not considered overly aggressive as only 7.6% of these patients receive chemotherapy within the last two weeks of life. To determine how aggressive care near the end of life really is, however, we suggest evaluating newly started chemotherapy alongside ongoing treatment. As the line between the effects (beneficience) and side effects (nonmaleficience) of chemotherapy is often very narrow, doctors and patients have to work together to find the best way of treading this fine line.

Chemotherapy Near the End of Life for Chinese Patients with Solid Malignancies

“…In accordance with what we found, a prospective study has revealed that patients receiving palliative chemotherapy were more likely to die in an intensive care unit rather than at home, compared with those not receiving this treatment . Through comparison, we found the median age of our cohort was relatively younger than what others have reported . In our study, patients younger than 56 years underwent more aggressive EOL chemotherapy but presented significantly better survival.…”

Chemotherapy in the last 30 days of life of advanced cancer patients

“…In our study, 116 (24.3 %) patients who died from advanced cancer received chemotherapy in the last month of life. Percentage is in line with literature data [1,[3][4][5][6][7]. It is commonly acknowledged that age, performance status, tumor sensitivity, survival prognosis, and comorbidities should be considered in every [4].…”

“…Signs of deterioration and side effects should be monitored closely to avoid overtreatment. The incidence of chemotherapy in the last month of life of patients with advanced cancer varies between 11.7 and 37 % [1,[3][4][5][6][7]. The reasons for this overtreatment are many.…”

Prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer

“…Studies have consistently shown that patients who receive end‐of‐life chemotherapy are younger . Older patients are more likely to value quality of life over life prolonging measures as compared to younger patients .…”