Chemotherapy (CT) near end of life is considered a marker of inadequate palliative care for cancer patients. The objectives of our work were to determine the influence of palliative care at home and the distance between the residence area and the cancer referral center on the interval between last chemotherapy cycle and death.
A retrospective observational study was conducted in a tertiary care hospital. All cancer patients deceased between January 2013 and June 2014 were included. Clinical, demographical and treatment variables were obtained from medical records.
Our population of 951 patients had a mean age of 63 years; male: 601 (63%), females: 350 (37%). Tumor locations: lung, 261 (28%); colorectal, 125 (13%); breast, 99 (10.7%); pancreas, 79 (8.8%). The table shows an analysis of the CT used in all patients, indicating a high proportion of CT use near the end of life (68% in the last 3 months). Average time elapsed between the end of treatment and death was significantly longer in the group of patients included in home palliative care programs (n = 111; 24.5%) vs. those not included (n = 367; 75.5%): 42.3 vs. 24.7 days (p < 0.05). CT was stopped earlier in patients belonging to geographical areas farther from the referral center, with median times between last cycle of CT and death of 14.9 days for patients living near the referral hospital versus 51.9 days for > 70 km (p = 0.041) and 58 days for > 100 km (p = 0.013).Table: 1522P
Analysis of CT use in all patients
|N = 901||n (%)|
|Treatment No CT CT||198 (22) 703 (78)|
|Nr of lines of CT 1 2 3 4 or more||441 (49) 198 (22) 135 (15) 127 (14)|
|Nr of drugs in last line of CT 1 2 3||378 (42) 414 (46) 109 (12)|
|CT in the last 3 months||604 (67)|
|CT in the last 4 weeks||405 (45)|
|CT in the last week||63 (7)|
In our population, a high percentage of CT was observed in the final stages of life, including a high use of third and successive lines of treatment. Patients included in home palliative care programs and/or belonging to more distant geographical areas finished active treatment before, thereby suggesting that both factors impact on decision making for patients with advanced cancer. Understanding the factors that determine the use of CT near the end of life may contribute to limit its inadequate indication.
Clinical trial identification
Legal entity responsible for the study
Hospital Universitario Santa Lucia, Cartagena.
Has not received any funding.
All authors have declared no conflicts of interest.