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- Title
Experiences with Prescribing Large Quantities of Systemic Anticancer Therapy Near Death.
- Authors
Baena-Cañada, José M.; Campini Bermejo, Alicia; Gámez Casado, Salvador; Rodríguez Pérez, Lourdes; Quílez Cutillas, Alicia; Calvete Candenas, Julio; Martínez Bautista, María J.; Benítez Rodríguez, Encarnación
- Abstract
Background: The most important decision after diagnosing terminal cancer is whether to provide active therapy or withhold treatment. Objective: To analyze the aggressiveness of care by evaluating systemic anticancer therapy (SACT) given near to death, describing this care and identifying factors that determine its use. Design: This involves retrospective observational cohorts study. Setting/Subjects: This involves patients with metastatic tumors who died at a University Hospital in Spain between 2015 and 2016. Measurements: Data obtained from prescribing oncologists and patients' clinical records, type of cancer, and information on treatment. The dependent variable used was the interval between the date of the last dose and date of death. Results: Ninety-four (32.60%) of 288 patients received SACT in the last month of life. This cohort had a higher frequency of lung cancer (OR: 1.58; CI 95%: 1.14–2.18), received more care from oncologist 2 (OR: 1.50; CI 95%: 1.08–2.08), had fewer last-line treatment cycles (OR: 1.28; CI 95%: 1.13–1.45), a lower subjective response (OR: 3.13; CI 95%: 1.34–7.29), less clinical benefit (OR: 2.38; CI 95%: 1.04–5.55), more visits to the Emergency Department (OR: 1.59; CI 95%: 1.06–2.38), and less care from the Palliative Care Unit (OR: 4.55; CI 95%: 2.69–7.70). In multivariate analysis, the predictors of having received SACT close to death remained: receiving fewer cycles of treatment (OR: 1.28; CI 95%: 1.12–1.47) and less palliative care (OR: 4.54; CI 95%: 2.56–7.69). Conclusions: A third of cancer patients received SACT in the last month of life with less efficacy and poorer quality of care than patients not receiving it.
- Subjects
SPAIN; TERMINAL care &; psychology; ACADEMIC medical centers; ANTINEOPLASTIC agents; CANCER patient medical care; CONFIDENCE intervals; DOSE-effect relationship in pharmacology; DRUG prescribing; HOSPITAL emergency services; LONGITUDINAL method; LUNG tumors; MEDICAL quality control; MEDICAL research; MULTIVARIATE analysis; SCIENTIFIC observation; PALLIATIVE treatment; TERMINALLY ill; PHYSICIAN practice patterns; RETROSPECTIVE studies; DESCRIPTIVE statistics; ODDS ratio
- Publication
Journal of Palliative Medicine, 2019, Vol 22, Issue 12, p1515
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2019.0017