Patient attitudes towards chemotherapy and survival: A prospective observational study in advanced non-small cell lung cancer

Chu, Da-Tong; Hsu, Hua‐Yi; Çok, Gürsel; Roubec, Jaromı́r; Patil, Shekhar; Damyanov, Danail; West, Teena; Hall, Belinda J.; Altuǧ, Sedat

doi:10.1016/j.lungcan.2009.01.022

Cited by 14 publications

(15 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is often patients themselves who request oncological treatment, despite a hopeless disease situation and an unfavorable risk–benefit ratio. Chu et al [9] clearly showed that patients with advanced, incurable cancer often aim to achieve the maximum gain in life expectancy while accepting a high level of toxicity. Slevin et al [10] showed that cancer patients were willing to undergo burdensome chemotherapy even when the likelihood of a cure was only 1%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

et al. 2017

View full text Add to dashboard Cite

BackgroundCancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care.AimTo describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital.MethodsRetrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life.ResultsOverall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient’s life.ConclusionsOverambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of specialist palliative care.

show abstract

Section: Discussionmentioning

confidence: 99%

“…When is aggressive therapy justified towards the end of life, and when should attention turn towards palliative care? It is not an easy decision, and it is also made more difficult by patients sometimes requesting intensive treatment measures even when the prognosis is extremely limited [9,10]. …”

Section: Introductionmentioning

confidence: 99%

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Some authors claim that older patients expect greater benefits [11,12]. Other studies as well as our own did not show any association between patient age and anticipated survival benefits from palliative chemotherapy [10,13]. …”

Section: Discussionmentioning

confidence: 50%

“…In a study by Brundage et al, the expectations of more than half of the participants exceeded the estimated, realistic survival benefit defined prior to survey [12]. Chu et al found that 60.0% of their advanced NSCLC patients would prefer a maximum extension of survival with the acceptance of high toxicity [13]. Additionally, in a Korean survey, patients with metastatic solid cancers requested a two-fold longer survival threshold than previous studies had suggested [14].…”

Section: Discussionmentioning

confidence: 99%

Patients’ perspectives on palliative chemotherapy of colorectal and non - colorectal cancer: a prospective study in a chemotherapy- experienced population

et al. 2013

View full text Add to dashboard Cite

BackgroundA better understanding of patients’ views on the benefit and burden obtained from palliative chemotherapy would facilitate shared decision making. We evaluated palliative cancer patients’ reported outcomes (PROs) for toxicity and investigated the survival threshold for which they would repeat chemotherapy (CTx).MethodsPatients who had received a minimum of three months of palliative CTx for advanced colorectal (CRC) or non-colorectal (non-CRC: upper gastrointestinal, lung and head-and-neck) cancer were assessed by questionnaire. Patients were questioned about PROs for toxicity, subjective burden from side effects, and were asked for the survival threshold necessary for them to repeat CTx. Expected survival (sum of indicated survival threshold and median survival time with best supportive care) was compared to the patients’ actual survival.ResultsOne hundred and thirty-four patients (CRC: 58; non-CRC: 76) were surveyed. The most frequent PRO- grade 3/4 toxicities were acne (12.8%), fatigue (9.0%), and diarrhea (8.5%). The symptom causing the highest subjective burden was fatigue and was worse than expected in 29.9% of the patients. The median survival threshold for which patients would repeat CTx was significantly longer in CRC than in non-CRC patients (p=0.01). Median expected survival was significantly longer than actual median survival (CRC: 44.0 months [22.0-65.9] compared with 30.0 months of actual survival [20.9-39.1]; non-CRC: 22.0 months [15.3-28.6] compared with 19.0 months of actual survival [15.1-22.9], p=0.03).ConclusionFatigue deserves more attention when toxicity of treatment and symptoms of disease are explained to patients. Patients’ survival expectations from palliative chemotherapy are higher than previously described, exceed the median survival time known from phase III trials, and are significantly longer than their actual survival.

show abstract

“…Conclusion: Based on our results, we strongly believe that early palliative care when integrated into standard oncological treatment in advance stage cancer patients can prolong patient's survival. serious treatment measures notwithstanding when the prognosis is dismal [1][2]. A definitive objective of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis.Earle et al characterized specific clinical quality indicators for overtreatment, incorrect treatment, and undertreatment during the end of the life [3].…”

mentioning

confidence: 99%

Impact of early palliative care on survival in advanced-stage cancer patients: An institution-based retrospective cross-sectional study

Thakur

Ghoshal

2019

Asian Pac J Cancer Care

View full text Add to dashboard Cite

Background: While treating patients with the advanced disease it becomes very challenging for the clinicians to decide as to when the active treatment is justified and when should palliative care be introduced in patient's treatment. American Society of Clinical Oncology (ASCO) suggested that patients with advanced cancer, regardless of patient or outpatient, should receive dedicated palliative care services, early in the disease course, simultaneous with active treatment. Similar recommendations have been proposed by the European Society of Medical Oncology (ESMO). Keeping in view this background, we aimed to do this study. Aim: To study the impact of the introduction of early palliative care into routine oncological management on patient's survival. Methods: This retrospective cross-sectional study is based on hospital data for patients who died in the hospice between the year 2017 and 2018. The complete information including age, gender, date of death, diagnosis, procedures, and medical interventions, as well as the date of documentation, was obtained of each patient. Results: A total of 27 patients were enrolled in this study. The mean age at presentation was 50.3 years. 11 (40.7%) patients received oncological treatment integrated with palliative care in the last month of life. The median duration of survival from diagnosis till death was 7 months in the patients who received only palliative care and 10 months in patients who received integrated onco-palliative care in the last month of life (P=0.452). 14 (51.8%) patients received early palliative care. The median survival of the patients who received early palliative care and of those who were offered palliative care towards the end of life was 8.5 months and 7 months respectively (P=0.040). Conclusion: Based on our results, we strongly believe that early palliative care when integrated into standard oncological treatment in advance stage cancer patients can prolong patient's survival. serious treatment measures notwithstanding when the prognosis is dismal [1][2]. A definitive objective of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis.Earle et al. characterized specific clinical quality indicators for overtreatment, incorrect treatment, and undertreatment during the end of the life [3]. The indicators distinguished were: 1) receiving chemotherapy in the last 14 days of life and/or start of chemotherapy during the last 30 days of life (overtreatment); 2) more than one emergency hospital admission and/or intensive-care unit admission during the last month of life (incorrect treatment); 3) involvement of hospice and/or specialized palliative services less than 3 days before death

show abstract

Patient attitudes towards chemotherapy and survival: A prospective observational study in advanced non-small cell lung cancer

Cited by 14 publications

References 33 publications

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014

Patients’ perspectives on palliative chemotherapy of colorectal and non - colorectal cancer: a prospective study in a chemotherapy- experienced population

Impact of early palliative care on survival in advanced-stage cancer patients: An institution-based retrospective cross-sectional study

Contact Info

Product

Resources

About