Department of Hematology-Oncology, National University Hospital, National University Health System, Singapore.
J Palliat Med. 2012 Sep;15(9):991-7. doi: 10.1089/jpm.2012.0050. Epub 2012 Jul 13.
We describe the use of systemic therapy in advanced cancer patients admitted to an acute care hospital, with a focus on targeted therapy. We aim to spotlight the utilization of targeted agents in the last months of life.
Adult patients (N=252) with advanced solid tumors who died as inpatients in the National University Hospital, Singapore, were included in this retrospective study. Patients' demographic and clinical data were extracted from hospital records. Information on systemic therapy was extracted from the time of diagnosis and all other data limited to the last three months before death.
187 adult patients received palliative systemic therapy from the time of diagnosis, of which 125 (66.8%) received it within three months of death. Of patients receiving only nontargeted systemic treatment (n=106), 60 (56.6%) and 26 (24.5%) received it within three months and one month of death respectively. Comparatively, 81 patients received palliative targeted systemic therapy, of which 65 (80.3%) and 40 (49.4%) had treatment within three months and one month of death respectively (p=0.001 and p<0.001). Targeted therapy was first initiated in the last three months of life in 38 patients. Oral agents targeting epidermal growth factor receptor (lung cancer patients) and vascular endothelial growth factor receptor (non-lung cancer patients) pathways were commonly employed. Lung cancer patients were more likely to have targeted therapy as their last line of systemic therapy: 26/54 lung cancer patients compared with 29/133 non-lung cancer patients (48.1% versus 21.8%, p<0.001).
Targeted therapy is used in more than half of patients who received systemic therapy within three months of death. The degree to which these agents are being utilized near the end of life suggests the need to reexamine the risk/benefit profile of targeted therapy for this population, and the decision-making process around their use.
我们描述了在急性护理医院收治的晚期癌症患者中使用全身治疗的情况，重点是靶向治疗。我们旨在关注在生命的最后几个月中使用靶向药物。
这项回顾性研究纳入了在新加坡国立大学医院住院期间死亡的 252 名晚期实体瘤成年患者。从医院记录中提取患者的人口统计学和临床数据。从诊断时起提取全身治疗信息，所有其他数据仅限于死亡前三个月。
187 名成年患者从诊断时起接受姑息性全身治疗，其中 125 名（66.8%）在死亡前三个月内接受治疗。仅接受非靶向全身治疗的患者中，60 名（56.6%）和 26 名（24.5%）分别在死亡前三个月和一个月内接受治疗。相比之下，81 名患者接受姑息性靶向全身治疗，其中 65 名（80.3%）和 40 名（49.4%）分别在死亡前三个月和一个月内接受治疗（p=0.001 和 p<0.001）。靶向治疗在 38 名患者生命的最后三个月内首次开始。针对表皮生长因子受体（肺癌患者）和血管内皮生长因子受体（非肺癌患者）途径的口服药物通常被使用。肺癌患者更有可能将靶向治疗作为其最后一线全身治疗：54 名肺癌患者中有 26 名（48.1%），而非肺癌患者中有 133 名中有 29 名（21.8%）（p<0.001）。
在死亡前三个月内接受全身治疗的患者中，有超过一半的患者使用了靶向治疗。这些药物在生命末期的使用程度表明，需要重新审视针对这一人群的靶向治疗的风险/获益情况，以及这些药物使用的决策过程。
