Avoiding Harmful Palliative Chemotherapy Treatment in the End of Life: Development of a Brief Patient-Completed Questionnaire for Routine Assessment of Performance Status

2012 ◽  
Vol 10 (6) ◽  
pp. 230-237 ◽  
Author(s):  
Ulla Näppä ◽  
Olav Lindqvist ◽  
Bertil Axelsson
Keyword(s):  
End Of Life ◽  
Palliative Chemotherapy ◽  
Performance Status ◽  
Chemotherapy Treatment ◽  
Assessment Of Performance ◽  
Routine Assessment

Use of Palliative Chemo- and Radiotherapy at the End of Life in Patients With Cancer: A Retrospective Cohort Study

2016 ◽  
Vol 34 (9) ◽  
pp. 801-805 ◽  
Author(s):  
Zhe Zhang ◽  
Xiao-Li Gu ◽  
Meng-Lei Chen ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Performance Status ◽  
Terminally Ill ◽  
Cardiovascular Complications ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Terminally Ill Patients

Background: Administration of chemotherapy and radiotherapy near the end of life is a frequently discussed issue nowadays. We have evaluated the factors associated with the use of chemotherapy and radiotherapy at the end of life among terminally ill patients in China. Methods: This study included the data from patients who had died from advanced cancer who underwent palliative chemotherapy and radiotherapy between January 2007 and December 2013 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the factors independently associated with the use of chemo- and radiotherapy. Results: Among the 410 patients included (median age, 68 years; range, 18-93; 53% males), 47 (11.5%) underwent palliative chemotherapy and 28 (6.8%) underwent radiotherapy in the last 30 days. Age <65 years (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.06-2.88), performance status <3 (OR: 3.95; 95% CI: 1.56-5.07), and cardiopulmonary resuscitation (OR: 4.09, 95% CI: 2.66-5.34) were independently associated with the use of chemotherapy. Performance status <3 (OR: 4.06, 95% CI: 2.17-5.83) and cardiopulmonary resuscitation (OR: 5.28, 95% CI: 3.77-7.21) were independently associated with the use of radiotherapy. Conclusion: The findings indicate that younger patients with a lower performance status who do not have complications are more likely to opt for chemo- or radiotherapy. Further, the use of palliative chemo- and radiotherapy should be considered carefully in terminally ill patients with cancer, as they seem to indicate a higher risk of cardiovascular complications requiring resuscitation.

When should anti-cancer treatment be ended? Why and when to discontinue palliative chemotherapy.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 41-41
Author(s):  
Yuurin Kondo ◽  
Maria Michiko Nakajima ◽  
Go Nakajima ◽  
Kazuhiko Hayashi
Keyword(s):  
Life Expectancy ◽  
End Of Life ◽  
Palliative Chemotherapy ◽  
Performance Status ◽  
Poor Performance ◽  
Poor Performance Status ◽  
Incurable Cancer ◽  
Clear Explanation ◽  
Anti Cancer ◽  
Practice Methods

41 Background: Currently, palliative chemotherapy (PC) near the end of life is frequently discussed. It is important to know when it is appropriate to end PC to maintain the best quality of life. The criteria for discontinuation of anti-cancer therapy are often “exacerbation of patient’s condition,” “problems with toxicity,” or “patient refusal.” However, there is no clear agreement regarding when to end PC. Ending treatment is one of the most difficult decisions for oncologists. The purpose of this study was to determine clear reasons for the discontinuation of PC and to gain an understanding of the current situation regarding explanation of prognosis in clinical practice. Methods: This retrospective study included 144 patients with incurable cancer who had received PC and died between January 2014 and November 2016. We examined the reasons for discontinuation of PC and whether patients had completed end-of-life discussions, including a discussion of life expectancy, when their PC was terminated. Results: Causes of discontinuation of PC were as follows: 8.3% patient’s desire, progressive disease (PD) in 48.5%, poor performance status (PS) in 20.1%, and toxicity in 17.4%. In patients who chose to end anticancer therapy voluntarily, all patients received a clear explanation of their prognosis, including life expectancy. Among 67 patients with PD, 45 (67.1%) received information regarding their prognosis; 17 of 29 patients (58.6%) with poor PS received similar information. Among patients who ended PC due to toxicity, only 8 of 25 patients (32%) completed end-of-life discussions, including a discussion of life expectancy. In addition, death within 1 month from the discontinuation of PC occurred in 0 cases where treatment was discontinued due to patient’s desire, 10 cases (15%) due to PD, 10 cases (34.4%) due to PS, and 7 cases (28%) due to toxicity. Conclusions: This study shows that patients who discontinued treatment due to poor PS or toxicity had a shorter interval between the final PC and death. Moreover, it indicated that the details of the end-of-life discussion might be influenced by the reason for discontinuation of PC, including or excluding a discussion of life expectancy.

Palliative Chemotherapy Near the End of Life in Oncology Patients

2018 ◽  
Vol 35 (9) ◽  
pp. 1215-1220 ◽  
Author(s):  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Age Groups ◽  
Treatment Strategies ◽  
Cancer Center ◽  
Eol Care ◽  
To Receive

Background: Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL. Methods: This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy. Results: Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001). Conclusion: The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.

scholarly journals Chemotherapy and Targeted Therapy Near the end of life Affects Aggressiveness of Palliative Care

2020 ◽  
Author(s):  
Wen-Wu Cheng ◽  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu
Keyword(s):  
Targeted Therapy ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Cancer Center ◽  
Integrated Therapy ◽  
The Difference ◽  
To Receive

Abstract Background: In patients with advanced cancer, considering the increased application of targeted therapy and immunotherapies, we explored the difference between indicators of chemotherapy and targeted therapy in the last month of life.Methods: Electronic medical data of patients who died from metastatic cancer and received targeted therapy and palliative chemotherapy from April 2007 to December 2018 at the Department of Integrated Therapy, Fudan University Shanghai Cancer Center were analyzed retrospectively. To determine those variables that were judged to be independent predictors of the use of palliative chemotherapy and targeted therapy, and the differences between them, univariate and multivariate analyses were used.Results: Of the 585 patients included in the study, 87 (14.9%) received palliative chemotherapy and 125 (21.3%) underwent targeted therapy during the last month. Patients who received continued chemotherapy within the last month were subjected to more intensive treatment (admitted to an intensive care unit (ICU) in the last month of life (OR, 2.33; CI [1.91–2.92], P < 0.001), and received cardiopulmonary resuscitation(OR, 4.18; CI [2.91–5.40],P < 0.001)), than those who did not. Analysis of subgroups showed that the lung cancer was independently associated with targeted therapy, and admission to an ICU was independently associated with palliative chemotherapy.Conclusions: Younger patients without complications and with better performance status were more likely to receive chemotherapy. Lower rates of cardiopulmonary resuscitation and admission to ICU correlated with receipt of targeted therapy at the end of life compared with those who received chemotherapy in the last 30 days.

Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status

2011 ◽  
Vol 13 (6) ◽  
pp. 426-429 ◽  
Author(s):  
Alfonso Sánchez-Muñoz ◽  
Elisabeth Pérez-Ruiz ◽  
María Isabel Sáez ◽  
José Manuel Trigo ◽  
M. Mar Galindo ◽  
...  
Keyword(s):  
Palliative Chemotherapy ◽  
Performance Status ◽  
Poor Performance ◽  
Solid Tumours ◽  
Poor Performance Status ◽  
Limited Impact

scholarly journals Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review

2021 ◽  
pp. 026921632110073
Author(s):  
Christine Lau ◽  
Christopher Meaney ◽  
Matthew Morgan ◽  
Rose Cook ◽  
Camilla Zimmermann ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Performance Status ◽  
Retrospective Chart Review ◽  
Care Needs ◽  
Care Facilities ◽  
Palliative Care Services ◽  
Low Performance ◽  
Electronic Referral

Background: To date, little is known about the characteristics of patients who are admitted to a palliative care bed for end-of-life care. Previous data suggest that there are disparities in access to palliative care services based on age, sex, diagnosis, and socioeconomic status, but it is unclear whether these differences impact access to a palliative care bed. Aim: To better identify patient factors associated with the likelihood/rate of admission to a palliative care bed. Design: A retrospective chart review of all initiated palliative care bed applications through an electronic referral program was conducted over a 24-month period. Setting/participants: Patients who apply and are admitted to a palliative care bed in a Canadian metropolitan city. Results: A total of 2743 patients made a total of 5202 bed applications to 9 hospice/palliative care units in 2015–2016. Referred and admitted cancer patients were younger, male, and more functional than compared to non-cancer patients (all p < 0.001). Referred and admitted patients without cancer were more advanced in their illness trajectory, with an anticipated prognosis <1 month and Palliative Performance Status of 10%–20% (all p < 0.001). On multivariate analysis, a diagnosis of cancer and a prognosis of <3 months were associated with increased likelihood and/or rate of admission to a bed, whereas the presence of care needs, a longer prognosis and a PPS of 30%–40% were associated with decreased rates and/or likelihood of admission. Conclusion: Patients without cancer have reduced access to palliative care facilities at end-of-life compared to patients with cancer; at the time of their application and admission, they are “sicker” with very low performance status and poorer prognoses. Further studies investigating disease-specific clinical variables and support requirements may provide more insights into these observed disparities.

scholarly journals Functional capacity of women with breast neoplasm undergoing palliative chemotherapy

2021 ◽  
Vol 55 ◽  
Author(s):  
Suzy Ramos Rocha ◽  
Carla Andreia Vilanova Marques
Keyword(s):  
Breast Neoplasm ◽  
Functional Capacity ◽  
Palliative Chemotherapy ◽  
Ductal Carcinoma ◽  
Histological Grade ◽  
Performance Status ◽  
Cross Sectional Study ◽  
Moderate Activity ◽  
Cross Sectional ◽  
Activity Restriction

ABSTRACT Objective: To evaluate the functional capacity of women with breast neoplasm undergoing palliative chemotherapy. Method: Cross-sectional study with an analysis of medical records of women with breast cancer undergoing palliative chemotherapy. Results: Out of one hundred evaluated records, most registered 50 years or older (66%), primary education (53%), an income of 1 to 2 minimum wages (87%), invasive ductal carcinoma (95%), positive hormone receptor (64%), and histological grade 1 and 2 (57%). Performance status 0 (49%), 1 (39%), and 2 (12%) were prevalent; these imply, respectively, active patients, with mild and moderate activity restriction. One to four chemotherapy schemes were associated with the inappetence (p =0.00) and weight loss (p =0.001) symptoms. The main complications were neuropathy (31%), medullary compression syndrome (21%), neutropenia (9%), and death (28%). Conclusion: Out of the analyzed women, 88% presented functional capacity 0 and 1, had no or mild restriction of daily activities, were multiply treated, and manifested manageable symptoms. Others, however, presented moderate to severe clinical complications during the treatment, progressing to exclusive palliative care or death.

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