Antineoplastic therapy near the end of life: A retrospective analysis of the clinical practice in oncological adult patients

Background

Around 70% of oncological patients with disseminated disease are receiving chemotherapy with palliative intent. However, giving palliative chemotherapy near the end of life, is a balance between clinical benefit and potential harm in terms of side effects. Treatment interruption in the final stages of life is considered a factor determining good clinical practice. Earle et al. (J Clin Oncol 2004) define the concept of treatment non-aggressiveness as chemotherapy administration below 10% during the last 14 days of life.

Methods

A retrospective observational study was conducted in a tertiary hospital.The study included all oncological patients with advanced cancer who died between January 2014 and august 2015. For descriptive analysis, the statistical program SPSS ® was used.

Results

Between January 2013 and August 2015, 452 patients with oncological advanced disease and palliative follow-up care, died. 67% (n = 306) of these patients had received antineoplastic treatment. These are the patients that were analyzed. The median age of patients was 64.5 years (range 17-86), 66.7% (n = 208) was male and 33.3% (n = 104) was female. The most frequent tumors suffered by patients were 30.4% (n = 95) lung cancer and 14.1% (n = 44) colorectal cancer. The median number of treatment regimens received was 2 (range 1-9). There were 69 patients who received more than 3 different regimens (22.5%). 57.8% (n = 177) of the patients maintained the antineoplastic treatment during the last 3 months before death; 20.6% (n = 63) of the patients received chemotherapy in the last 30 days of life; and 10.1% (n = 31) received chemotherapy in the last 14 days of life. 78% (n = 237) of the patients died at hospital, and 22% (n = 67) died at home.

Conclusions

The use of chemotherapy during the last period of life of cancer patients is a controversial issue.The outcomes of our study show that the proportion of patients in the oncology department who received chemotherapy at the last stage of life is similar to that observed by Earle et al. We need more scientific evidence that consolidate data allowing us to establish criteria for the selection of patients who may benefit from receiving antineoplastic treatment.

Clinical trial identification

Legal entity responsible for the study

N/A

Funding

Hospital Insular Las Palmas

Disclosure

All authors have declared no conflicts of interest.