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Use of chemotherapy near the end of life: what factors matter?

Use of chemotherapy near the end of life: what factors matter?

Authors :
Régis Aubry
Yvan Beaussant
Jean-Luc Raoul
Philippe Rochigneux
Lucas Morin
F. Goldwasser
Christophe Tournigand
Centre de Recherche en Cancérologie de Marseille (CRCM)
Aix Marseille Université (AMU)-Institut Paoli-Calmettes
Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Institut Paoli-Calmettes
Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)
Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)
Hôpital Cochin [AP-HP]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
CHU Henri Mondor [Créteil]
Karolinska Institute
CHU Henri Mondor
ROCHIGNEUX, Philippe
Source :
Annals of Oncology, Annals of Oncology, 2017, 28 (4), pp.809-817. ⟨10.1093/annonc/mdw654⟩
Publication Year :
2016

Abstract

Background Use of chemotherapy near the end of life in patients with metastatic cancer is often ineffective and toxic. Data about the factors associated with its use remain scarce, especially in Europe. Methods Nationwide, register-based study including all hospitalized patients aged ≥20 years who died from metastatic solid tumors in France between 2010 and 2013. Results A total of 279 846 hospitalized patients who died from metastatic cancer were included. During the last month before death, 19.5% received chemotherapy (including 11.3% during the last 2 weeks). Female sex (OR= 0.96, 95% CI= 0.93–0.98), older age (OR= 0.70, 95% CI= 0.69–0.71 for each 10-year increase) and higher number of chronic comorbidities (OR= 0.83, 95% CI= 0.82–0.84) were independently associated with lower rates of chemotherapy. Although patients with chemosensitive tumors were statistically more likely to receive chemotherapy during the last month before death (OR= 1.21, 1.18–1.25), this association was mostly fueled by testis and ovary tumors and we found no obvious pattern between the expected chemosensitivity of different cancers and the rates of chemotherapy use close to death. Compared with university hospitals, patients who died in for-profit clinics/hospital (OR= 1.40, 95% CI= 1.34–1.45), or comprehensive cancer centers (OR= 1.43, 95% CI= 1.36–1.50) were more likely to receive chemotherapy. Finally, high-volume centers and hospitals without palliative care units reported greater-than-average rates of chemotherapy near the end of life. Conclusion among hospitalized patients with cancer, young individuals, treated in comprehensive cancer centers or in high-volume centers without palliative care units were the most likely to receive chemotherapy near the end of life. We found no evident pattern between the expected chemosensitivity of different cancers and the probability for patients to receive chemotherapy close to death.

Details

ISSN :
15698041 and 09237534
Volume :
28
Issue :
4
Database :
OpenAIRE
Journal :
Annals of oncology : official journal of the European Society for Medical Oncology
Accession number :
edsair.doi.dedup.....70fc203a258e2ac30d1171483f4b15e0
Full Text :
https://doi.org/10.1093/annonc/mdw654⟩