Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study

Besseling, Joost; Reitsma, Jan; Erkelens, Judith A van; Schepens, M.H.J.; Siroen, Michiel P. C.; Plantes, Cathelijne M. P. Ziedses des; Henegouwen, Mark I. van Berge; Beerepoot, Laurens V.; Voorthuizen, Theo van; Zuylen, Lia van; Verhoeven, Rob H.A.; Laarhoven, Hanneke W. M. van

doi:10.3390/cancers13010145

Cited by 10 publications

(11 citation statements)

References 25 publications

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“…In a cross-national European end of life study in cancer and non-cancer patients from general practitioners, hospital death rates were lowest for Dutch patients (28%), and highest for Italian patients (39%) [ 24 ]. We reported a hospital death rate of 25% (4% in the ICU), comparable to the rate in a recent Dutch insurance data study in upper gastro-intestinal (GI) cancer patients of whom 23% died in the hospital [ 25 ]. In metastatic breast cancer, one French and one US study reported in-hospital death rates of 70% [ 21 ] and 19% [ 26 ], respectively.…”

Section: Discussionsupporting

confidence: 73%

“…Other factors related to more chemotherapy prescriptions shortly before death in ABC were younger age [ 29 , 30 ], higher albumin levels [ 29 ], greater disease burden [ 30 ], more prior lines of chemotherapy [ 30 ], and in this study we found HR−/HER2− breast cancer, and survival time <1 year as related factors. Larger hospital size was associated with fewer chemotherapy prescription shortly before death in the Dutch GI cancer study [ 25 ]. Chemotherapy prescription shortly before death is associated with less palliative care, and more death in the hospital [ 21 , 32 ], the latter also being observed in the current study.…”

Section: Discussionmentioning

confidence: 99%

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Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer

Schmitz

Geurts

Ibragimova

et al. 2021

Cancers

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New treatment options in cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). From the Southeast Netherlands Breast cancer (SONABRE) registry, we selected all deceased patients diagnosed with ABC in Maastricht University Medical Center between January 2007 and October 2017. Frequency of health care use in the last six months of life was described and predictors for health care use were assessed. Of 203 patients, 76% were admitted during the last six months, 6% to the intensive care unit (ICU) and 2% underwent cardiopulmonary resuscitation (CPR). Death in hospital occurred in 25%. Nine percent of patients received a new line of chemotherapy ≤30 days before death, which was associated with age <65 years and <1 year survival since diagnosis of metastases. In these patients, the hospital admission rate was 95%, of which 79% died in the hospital, mostly due to progressive disease (80%). In conclusion, the frequency of ICU-admission, CPR or a new line of chemotherapy ≤ 30 days before death was low. Most patients receiving a new line of chemotherapy ≤ 30 days before death, died in the hospital.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer

Schmitz

Geurts

Ibragimova

et al. 2021

Cancers

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“…A comparable registry-based analysis of chemotherapy use near the end-of-life in patients with gastroesophageal cancer, also performed in the Netherlands, reported slightly lower percentages of chemotherapy use in the last 3 and last month of life compared to our study [20]. ICU admissions were rare in both patient populations.…”

Section: Discussionsupporting

confidence: 47%

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

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e17612 Background: Patients with advanced ovarian cancer have a poor prognosis and can experience debilitating abdominal symptoms in the last phase of life. Several analyses, mainly performed in the United States (US), show high rates of chemotherapy administration, and emergency room and hospital visits near the end-of-life in this patient category. No large European studies are available, while the organisation of palliative care differs between the US and Europe and between European countries. We aimed to analyse the intensity of inpatient care near the end-of-life in the Netherlands and perform a cross-study comparison with previous reports. Methods: All patients with ovarian cancer that died in 2016 and 2017 were identified from the database of the foundation Dutch Hospital Data (DHD). For the last six months of life the following parameters of aggressive care were extracted: administration of chemotherapy, emergency room (ER) visits, surgical procedures, hospital and intensive care unit (ICU) admissions. Data were analysed for the cohort as a whole and separately for three age categories: < 60, 60-75 and > 75 years of age. The intensity of inpatient care was compared to previously reported European and US data. Results: A total of 2172 patients died with ovarian cancer in 2016 and 2017 in the Netherlands. Data on medical care use was available for 1775 patients. During the last 6 months of life, chemotherapy was given to half of the ovarian cancer patients and the same percentage of patients was admitted to hospital. Chemotherapy administration near the end-of-life was infrequent, with only 12% of patients receiving chemotherapy in the last month of life. Surgery and ICU admissions in the final 6 months of life were rare (< 10%). Our cohort showed the lowest percentages of all five indicators of aggressive care reported thus far. The use of chemotherapy in the six months prior to death was highest in patients 60-75 years of age compared to younger or older patients. ER visits and hospital admissions were less frequent in patients > 75 years of age compared to the younger age groups. Conclusions: Aggressive medical care use in the final 6 months of life in this Dutch cohort of ovarian cancer patients was lower than in other previously reported cohorts.

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“…Congruently, patients preferring not to know prognosis more often reported optimism, known to relate to fighting spirit, as a reason for wanting limited information [ 67 ]. Still, physicians should evaluate the adaptiveness of patients’ prognostic unawareness based on strong fighting spirit, since it may obstruct anticipation of the end-of-life [ 9 , 68 ]. Considering that patients’ readiness for prognostic discussions could evolve over time, physicians may need to explore patients’ prognostic information preferences repeatedly (e.g., “Some people like to know everything about their illness and what may happen in the future, others prefer not to know too many details.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of patients with advanced cancer preferring not to know prognosis: a multicenter survey study

et al. 2022

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Background For some patients with advanced cancer not knowing prognosis is essential. Yet, in an era of informed decision-making, the potential protective function of unawareness is easily overlooked. We aimed to investigate 1) the proportion of advanced cancer patients preferring not to know prognosis; 2) the reasons underlying patients’ prognostic information preference; 3) the characteristics associated with patients’ prognostic information preference; and 4) the concordance between physicians’ perceived and patients’ actual prognostic information preference. Methods This is a cross-sectional study with structured surveys (PROSPECT). Medical and thoracic oncologists included patients (n = 524), from seven Dutch hospitals, with metastatic/inoperable cancer and an expected median overall survival of ≤ 12 months. For analysis, descriptive statistics and logistic regression models were used. Results Twenty-five to 31% of patients preferred not to know a general life expectancy estimate or the 5/2/1-year mortality risk. Compared to patients preferring to know prognosis, patients preferring unawareness more often reported optimism, avoidance and inability to comprehend information as reasons for wanting limited information; and less often reported expectations of others, anxiety, autonomy and a sense of control as reasons for wanting complete information. Females (p < .05), patients receiving a further line of systemic treatment (p < .01) and patients with strong fighting spirit (p < .001) were more likely to prefer not to know prognosis. Concordance between physicians’ perceived and patients’ actual prognostic information preference was poor (kappa = 0.07). Conclusions We encourage physicians to explore patients’ prognostic information preferences and the underlying reasons explicitly, enabling individually tailored communication. Future studies may investigate changes in patients’ prognostic information preferences over time and examine the impact of prognostic disclosure on patients who prefer unawareness.

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Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study

Cited by 10 publications

References 25 publications

Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer

Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Characteristics of patients with advanced cancer preferring not to know prognosis: a multicenter survey study

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