109IN - It's time to stop: When to initiate palliative therapy

Date 27 September 2014
Event ESMO 2014
Session Optimal use of systemic therapy in the palliative setting
Topics Anti-Cancer Agents & Biologic Therapy
Palliative Care
Presenter Sofia Braga
Citation Annals of Oncology (2014) 25 (suppl_4): iv38-iv38. 10.1093/annonc/mdu314
Authors S. Braga
  • Oncologia, José de Mello Saúde, 2790-073 - Lisboa/PT




Cancer patients are frequently submitted to chemotherapy in the end of life (EoL) with no apparent survival benefit and with decrease in quality of life. This is reflected in increased aggressiveness of care, as measured by increased emergency room visits and acute care hospital admissions. We and others have performed retrospective studies showing that approximately 20% of solid tumor patients are being treated with systemic chemotherapy in the last month of life (1). It has been very hard to understand the reasons for this. We specifically sought evidence of patients and families asking for chemotherapy maintenance and, this occurrence in our data seems rare (2). The decision to prolong chemotherapy seems to be attributable to caring oncologists (3). This has made us question the early integration of palliative care. The US and Canada have some well developed palliative care programs and have shown that this integration is beneficial in prospective studies and in two randomized trials (4,5), whereas in Europe palliative care provision remains scattered and heterogeneous. Systemic anti-cancer therapy should not be used in patients with solid tumors who have the following characteristics: low performance status, no benefit from prior evidence-based interventions, not eligible for a clinical trial, and with no strong evidence supporting the clinical value of further anticancer treatment. However, it is still unclear which is the best cancer care approach in EoL, which is the critical time to stop anti-cancer therapy and what is the role of the patients/families' wishes in this decision. We perform multidisciplinary prospective research in the EoL to provide evidence to models in cancer care approaches, observational and randomized studies. Our purpose is to improve the care to EoL cancer patients through the development of health and care models that are more patient-centered, efficient and sustainable, while preventing and minimizing the negative impact of such a unique stage in the life of an individual, a family and a society. We aim to understand how to dignify EoL: what goes frequently wrong and can be better addressed and improved. 1 Braga et al., 2007, Psychooncology 2 Cassiano, 2013, J Thoracic Oncology 3 Braga, 2011, Ann Oncology 4 Temel et al., 2010, The New England Journal of Medicine 5 Zimmermann et al., 2014, Lancet.


The author has declared no conflicts of interest.