Cancer Res Treat.  2015 Oct;47(4):555-563. 10.4143/crt.2014.200.

Cancer Treatment near the End-of-Life Becomes More Aggressive: Changes in Trend during 10 Years at a Single Institute

• Choi Y
• Keam B
• Kim TM
• Lee SH
• Kim DW
• Heo DS

• KMID: 2403371
• DOI: http://doi.org/10.4143/crt.2014.200

Abstract

PURPOSE
The purpose of this study was to investigate and compare cancer treatment near the end-of-life (EOL) over a 10-year period.
MATERIALS AND METHODS
Patients with advanced solid cancer at Seoul National University Hospital who received palliative chemotherapy and had died were enrolled. We categorized the consecutive patients according to two time periods: 2002 (n=57) and 2012 (n=206). Aggressiveness of cancer treatment near the EOL was evaluated.
RESULTS
The median patient age was 62, and 65.4% of patients (n=172) were male. Time from the last chemotherapy to death (TCD) was found to have been significantly shortened, from 66.0 days to 34.0 days during 10 years (p < 0.001); 17% of patients received molecular targeted agents as the last chemotherapy regimen in 2012. The proportion of patients who received intensive care unit care within the last month increased from 1.8% in 2002 to 19.9% in 2012 (p < 0.001), and emergency room visits within the last month also increased from 22.8% to 74.8% (p < 0.001). Although hospice referral increased from 9.1% to 37.4% (p < 0.001), timing of referral was delayed from median 53 days to 8 days before death (p=0.004). Use of targeted agents as the last chemotherapy for over-two-regimen users was associated with shortened TCD (hazard ratio, 2.564; p=0.002).
CONCLUSION
Cancer treatment near the EOL became more aggressive over 10 years.

Keyword

Terminal care; Targeted molecular therapy; Hospices

MeSH Terms

Drug Therapy
Emergency Service, Hospital
Hospices
Humans
Intensive Care Units
Male
Molecular Targeted Therapy
Referral and Consultation
Seoul
Terminal Care

Figure

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  Fig. 1. Factors associated with time from last chemotherapy to death in 2012. (A) Time from last chemotherapy to death by number of regimens. (B) Time from last chemotherapy to death by use of targeted agents as the last chemotherapy. (C) Time from last chemotherapy to death by intensive care unit (ICU) care within the last month. (D) Time from last chemotherapy to death by use of targeted agents as the last chemotherapy (as third or more regimen).

Reference

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