End‐of‐life intravenous chemotherapy administration patterns in the treatment of Queensland lung and pancreas cancer patients: a 10‐year retrospective analysis

Abstract

Background: End-of-life (EOL) chemotherapy administration rates for solid tumours are 12-20% and are associated with a reduced quality of life, increased hospitalisation and incidence of death within an acute care facility. Aim:We sought to determine the rate of EOL chemotherapy in government and private hospitals and determine the impact on hospitalisations and location of death in lung and pancreatic cancer patients.Methods: Data were obtained from the Queensland Oncology Repository between 2005 and 2014. Lung (n = 16 501) and pancreatic cancer (n = 4144) deaths were analysed. EOL chemotherapy was determined to be within 30 days of death. Demographics, location of treatment and death are reported.Results: Chemotherapy was administered to 6518 (40%) lung cancer and 1694 (41%) pancreatic cancer patients. A total of 1474 (9%) and 477 (12%) patients, respectively, received EOL chemotherapy. EOL chemotherapy was more common in males and those with distant metastatic disease, while less likely in the elderly and those with a lower socioeconomic status. EOL chemotherapy was more prevalent in large hospitals and was more common in private compared with government hospitals for pancreatic cancer (30 vs 26%; P < 0.001), while it was similar for lung cancer (24 vs 22%; P = 0.115). Death after EOL chemotherapy compared with all cancer deaths was more common in an acute care facility (lung cancer: 60 vs 37%; P < 0.001; pancreatic cancer: 53 vs 36%; P < 0.001).Conclusions: EOL chemotherapy rates were similar to Australian yet marginally lower than international rates, with variation dependent on the size and type of facility and increased the rate of deaths within an acute care facility.

PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life

“…There were no significant differences in end-of-life anticancer therapy use between the three stratification levels, contrasting reports of more intensive end-of-life treatment in university hospitals than in smaller hospitals. 8 , 23 Norway’s public health care system ensures cancer treatment according to national anticancer therapy guidelines with negligible patient cost and has few private for-profit clinics.…”

“…Ninety-six started chemotherapy at a median of 36 (IQR 25-42) days and stopped at a median of 33 days (IQR 21-41) before death. Thirty patients started chemotherapy at a median of 18 days (IQR [12][13][14][15][16][17][18][19][20][21][22][23][24][25], with discontinuation at a median of 15 (IQR 10-21) days before death. Breakdown per group is reported in Table 2.…”

Termination of Palliative Chemotherapy Near the End of Life: A Retrospective Study of Gastrointestinal Cancer Patients

“…Despite evidence in multiple studies, 4 , 5 , 10 the number of patients near the end of life who receive chemotherapy has not decreased. It has been reported that >10% of patients with breast, 11 , 12 gastrointestinal, 8 , 13 and other 2 , 3 , 9 , 14 cancers receive palliative chemotherapy during the last four weeks of their lives. Several studies have identified younger age as a predictor for chemotherapy use during the last months of life.…”

Systemic Anticancer Treatment Near the End of Life: a Narrative Literature Review

“…According to Allen et al, 9–12% of lung and pancreatic cancer patients received EOL chemotherapy, with a higher prevalence in males with advanced metastatic cancer [ 47 ]. This was associated with higher rates of deaths within an acute care facility [ 47 ].…”