Fujisawa Daisuke, Temel Jennifer S, Traeger Lara, Greer Joseph A, Lennes Inga T, Mimura Masaru, Pirl William F
Massachusetts General Hospital Cancer Center, Boston, MA, USA.
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
Psychooncology. 2015 Dec;24(12):1731-7. doi: 10.1002/pon.3840. Epub 2015 May 8.
Administration of chemotherapy in the last 14 days of life is a widely recognized indicator of poor end-of-life (EOL) care. The current study aimed to investigate predictors of this outcome, focusing on patients' self-reported psychological symptoms.
This is a secondary analysis of a randomized controlled trial that examined the efficacy of early palliative care integrated with standard oncology practice in patients with metastatic non-small cell lung cancer (NSCLC). We analyzed associations between receipt of chemotherapy within 14 days of death and demographic, clinical, and quality-of-life variables in the 125 patients who received chemotherapy in the course of their illness and died during the 50-month follow-up.
Twenty-five patients (20%) received chemotherapy within the last 14 days of their life. Among demographic and clinical variables, only route of chemotherapy was significantly associated with receipt of chemotherapy within 14 days of death (oral 34.1% vs. intravenous (i.v.) 12.3%, p < 0.05). In the subsample of participants who received i.v. chemotherapy as their last regimen, greater anxiety and depression and lower quality of life in emotional, social, and existential domains were associated with greater likelihood of receiving chemotherapy at the EOL. These associations were not observed in patients who received oral chemotherapy as their last regimen.
Anxiety, depression, and worse psychological quality of life at early stage of treatment may be associated with the receipt of i.v. chemotherapy at the EOL. Further research is needed to examine how these factors might influence decision-making about the discontinuation of chemotherapy at the EOL.
在生命的最后14天进行化疗是公认的临终关怀质量差的指标。本研究旨在调查这一结果的预测因素，重点关注患者自我报告的心理症状。
这是一项对随机对照试验的二次分析，该试验检验了早期姑息治疗与标准肿瘤治疗相结合对转移性非小细胞肺癌（NSCLC）患者的疗效。我们分析了125例在病程中接受化疗并在50个月随访期间死亡的患者中，死亡前14天内接受化疗与人口统计学、临床和生活质量变量之间的关联。
25例患者（20%）在生命的最后14天内接受了化疗。在人口统计学和临床变量中，只有化疗途径与死亡前14天内接受化疗显著相关（口服34.1%对静脉注射（i.v.）12.3%，p<0.05）。在以静脉化疗作为最后治疗方案的参与者子样本中，更高的焦虑和抑郁以及在情感、社会和生存领域更低的生活质量与临终时接受化疗的可能性更大相关。在以口服化疗作为最后治疗方案的患者中未观察到这些关联。
治疗早期的焦虑、抑郁和较差的心理生活质量可能与临终时接受静脉化疗有关。需要进一步研究以检查这些因素如何影响临终时停止化疗的决策。
