Department of Oncology, City Hospital Waid, Tiechestrasse 99, CH-8037 Zurich, Switzerland.
Institute for Social Work and Health, University of Applied Sciences and Arts, Northwestern Switzerland FHNW, CH-4600 Olten, Switzerland.
BMC Palliat Care. 2014 May 22;13:26. doi: 10.1186/1472-684X-13-26. eCollection 2014.
Chemotherapy near the end of life is an issue frequently discussed nowadays. The concern is that chemotherapy could cause more harm than good in a palliative situation; this is even truer as the patient nears death. The objective of our study is to evaluate the aggressiveness of patient care near the end of life by determining how many cancer patients receive chemotherapy during their final weeks.
In a retrospective analysis of patient charts, we investigated whether cancer patients had been treated with chemotherapy during the last four or two weeks of life. If they had, we looked at whether treatment was ongoing or newly initiated.
Out of the 119 cancer patients who died in our hospital over two years, 14 (11.7%) received chemotherapy during the last four weeks of life, nine of whom (7.6%) in the last two weeks of life. Treatment had been ongoing in six (5%) and newly initiated for eight (6.7%) within four weeks of death. Corresponding figures for the last two weeks of life were seven patients (5.9%) who continued previously prescribed treatment and two (1.7%) who were started on chemotherapy. Patients given chemotherapy during the last four weeks of life were significantly younger than those who were not (p = 0.003).
Cancer patient care in our hospital is not considered overly aggressive as only 7.6% of these patients receive chemotherapy within the last two weeks of life. To determine how aggressive care near the end of life really is, however, we suggest evaluating newly started chemotherapy alongside ongoing treatment. As the line between the effects (beneficience) and side effects (nonmaleficience) of chemotherapy is often very narrow, doctors and patients have to work together to find the best way of treading this fine line.
化疗在生命末期的应用是当今经常讨论的问题。人们担心在姑息治疗的情况下，化疗弊大于利；当患者接近死亡时，情况更是如此。我们研究的目的是通过评估生命末期患者护理的侵袭性来确定有多少癌症患者在最后几周接受化疗。
我们通过回顾性分析患者病历，来研究癌症患者在生命的最后四周或两周内是否接受过化疗。如果他们接受了化疗，我们会查看治疗是在继续进行还是新开始的。
在我们医院两年内死亡的 119 例癌症患者中，有 14 例（11.7%）在生命的最后四周内接受了化疗，其中 9 例（7.6%）在生命的最后两周内接受了化疗。在死亡前四周内，有 6 例（5%）持续进行治疗，8 例（6.7%）新开始化疗。生命的最后两周内，分别有 7 例（5.9%）继续进行先前规定的治疗和 2 例（1.7%）开始化疗。接受化疗的患者明显比未接受化疗的患者年轻（p=0.003）。
我们医院对癌症患者的护理并不被认为过于激进，只有 7.6%的患者在生命的最后两周内接受化疗。然而，为了确定生命末期护理的激进程度，我们建议评估新开始的化疗与持续治疗一起。由于化疗的效果（有益性）和副作用（非恶性）之间的界限往往非常狭窄，医生和患者必须共同努力，找到这条细线的最佳处理方法。
