Too Much Too Late? Chemotherapy Administration at the End of Life: A Retrospective Observational Study

Wilkerson, David H.; Santos, Jennifer L.; Tan, Xiyan; Gomez, Teny Henry

doi:10.1177/1049909120966619

Cited by 9 publications

(14 citation statements)

References 32 publications

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“…Hospitalization has traditionally been associated with significant use of health care resources at the EOL including previous studies in patients with advanced cancer treated with traditional chemotherapy having high rates of hospitalization associated with ICU care before death. 7,11,25 Similar to the studies with chemotherapy, our study corroborates data where patients receiving ICIs in the last 30 days of life also had high rates of death in the hospital and low hospice enrollment. 10,11 Early involvement by palliative care specialists can improve patient quality of life and survival and reduce aggressive end-of-life care.…”

Section: Discussionsupporting

confidence: 87%

Administration of Immune Checkpoint Inhibitors Near the End of Life

Bloom

Saker

Glisch

et al. 2022

JCO Oncology Practice

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PURPOSE: Recent literature suggests an increasing use of systemic treatment in patients with advanced cancer near the end of life (EOL), partially driven by the increasing adoption of immune checkpoint inhibitors (ICIs). While studies have identified this trend, additional variables associated with ICI use at EOL are limited. Our aim was to characterize a population of patients who received a dose of ICI in the last 30 days of life. METHODS: We performed a manual retrospective chart review of patients ≥ 18 years who died within 30 days of receiving a dose of ICI. Metrics such as Eastern Cooperative Oncology Group performance status (ECOG PS), number of ICI doses, need for hospitalization, and numerous other variables were evaluated. RESULTS: Over a 4-year time period, 97 patients received an ICI at EOL. For 40% of patients, the ICI given in the 30 days before death was their only dose. Over 50% of patients had an ECOG PS of ≥ 2, including 17% of patients with an ECOG PS of 3. Over 60% were hospitalized, 65% visited the emergency department, 20% required intensive care unit admission, and 25% died in the hospital. CONCLUSION: Our study contributes to the ongoing literature regarding the risks and benefits of ICI use in patients with advanced cancer near the EOL. While accurate predictions regarding the EOL are challenging, oncologists may routinely use clinical factors such as ECOG PS along with patient preferences to guide recommendations and shared decision making. Ultimately, further follow-up studies to better characterize and prognosticate this population of patients are needed.

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Section: Discussionsupporting

confidence: 87%

Administration of Immune Checkpoint Inhibitors Near the End of Life

Bloom

Saker

Glisch

et al. 2022

JCO Oncology Practice

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“…Questions about starting or not a chemotherapy treatment, proceed to the next cycle, differentiate symptoms caused by the disease from symptoms caused by the treatment, are very fine limits and, in clinical practice, make some decisions more difficult. The fact that there are no guidelines to guide the cessation of chemotherapy treatments, makes the decision extremely challenging [11]. In our study, no prognostic modifying factors were identified that could help the decision to continue or not with treatments, whether factors related to the disease or the patient.…”

Section: Discussionmentioning

confidence: 72%

Chemotherapy at the End of Life – The Reality of an Oncological Centre

Fontes¹,

Rodrigues²,

Oliveira³

et al. 2022

JCTR

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Background: In advanced and incurable cancer disease, chemotherapy may be recommended if it improves the quality of life, even if it does not increase survival. However, in an end-of-life setting, the use of chemotherapy is controversial, with less clear indications and more individualized decisions. This study aimed to evaluate patients who received chemotherapy within the last three months of life, an indicator of the quality of care provided. Methods: We analyzed data from patients receiving chemotherapy in the last 3 months of life and who died from January 2018 to December 2020, in our Oncology Department. Results: It was found that 391 patients received chemotherapy in the last 3 months of life. Most had metastatic disease at diagnosis (71%, n=276) and were treated in a first-line setting. A more detailed analysis revealed that 50% (n=193) underwent treatment in the last month and 22% (n=42) in the last week of life. Most patients died due to disease progression, with 79% of deaths occurring in the hospital. Conclusions: This work puts into figures the reality of an Oncology Centre, revealing the investment made in fighting the disease and providing greater longevity to patients, with quality of life.

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“…This proportion of patients receiving treatment at end-of-life differs across cancer centres ranging from 2.88% to 15.7%. 4,8,9,[41][42][43] Our low baseline prevalence of aggressive cancer treatment at end-of-life is reassuring. There is however areas for improvement with respect to acute healthcare utilization at endof-life with 9.18% of decedents having ≥2 ED visits and 17.12% having ≥2 hospitalizations in their last 30 days of life.…”

Section: Discussionmentioning

confidence: 99%

Can an Integrated Palliative and Oncology Co-rounding Model Reduce Aggressive Care at the End of Life? Secondary Analysis of an Open-label Stepped-wedge Cluster-randomized Trial

Zhuang

Zhou

et al. 2023

Am J Hosp Palliat Care

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Background Clinical trial evidence on the effect of palliative care models in reducing aggressive end-of-life care is inconclusive. We previously reported on an integrated inpatient palliative care and medical oncology co-rounding model that significantly reduced hospital bed-days and postulate additional effect on reducing care aggressiveness. Objectives To compare the effect of a co-rounding model vs usual care in reducing receipt of aggressive treatment at end-of-life. Methods Secondary analysis of an open-label stepped-wedge cluster-randomized trial comparing two integrated palliative care models within the inpatient oncology setting. The co-rounding model involved pooling specialist palliative care and oncology into one team with daily review of admission issues, while usual care constituted discretionary specialist palliative care referrals by the oncology team. We compared odds of receiving aggressive care at end-of-life: acute healthcare utilization in last 30 days of life, death in hospital, and cancer treatment in last 14 days of life between patients in two trial arms. Results 2145 patients were included in the analysis, and 1803 patients died by 4th April 2021. Median overall survival was 4.90 (4.07 – 5.72) months in co-rounding and 3.75 (3.22 – 4.21) months in usual care, with no difference in survival (P = .12). We found no significant differences between both models with respect to receipt of aggressive care at end-of-life. (Odds Ratio .67 – 1.27; all P > .05) Conclusion The co-rounding model within an inpatient setting did not reduce aggressiveness of care at end-of-life. This could be due in part to the overall focus on resolving episodic admission issues.

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Too Much Too Late? Chemotherapy Administration at the End of Life: A Retrospective Observational Study

Cited by 9 publications

References 32 publications

Administration of Immune Checkpoint Inhibitors Near the End of Life

Administration of Immune Checkpoint Inhibitors Near the End of Life

Chemotherapy at the End of Life – The Reality of an Oncological Centre

Can an Integrated Palliative and Oncology Co-rounding Model Reduce Aggressive Care at the End of Life? Secondary Analysis of an Open-label Stepped-wedge Cluster-randomized Trial

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