Mathew Aju, Achkar Tala, Abberbock Shira, Sandhu Gurprataap S, Jacob Mini Elizabeth, Villgran Vipin Das, Rosenzweig Margaret Q, Puhalla Shannon, Brufsky Adam M
University of Kentucky, Markey Cancer Center, Lexington, KY, USA.
University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA.
Breast J. 2017 Nov;23(6):718-722. doi: 10.1111/tbj.12905. Epub 2017 Aug 28.
Cessation of chemotherapy in the last few weeks of life could be an important quality-of-care benchmark. Proportion of metastatic breast cancer patients who receive end-of-life chemotherapy is not well described. We aimed to determine the prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer. A retrospective cohort study using a prospectively collated database of patients with metastatic breast cancer who died between January 1, 2010, and September 30, 2014, was conducted. End-of-life chemotherapy (EOLC) use was defined as receipt of chemotherapy within 2 weeks of death (EOLC2) and receipt of chemotherapy within 4 weeks of death (EOLC4). Patients who did not receive any chemotherapy in the last 4 weeks before death were categorized as non-EOLC. We identified 274 patients with metastatic breast cancer, of whom 28 received EOLC2 (10.2%) and 62 received EOLC4 (22.6%). In comparison with non-EOLC, patients receiving EOLC4 were younger and had greater disease burden. Patients in EOLC4 group received more number of lines of chemotherapy. In a multivariable analysis, younger age at metastatic disease and greater number of metastatic organ systems involved were predictors of end-of-life chemotherapy use. Prevalence of the use of end-of-life chemotherapy in our cohort was higher than previously described. More end-of-life chemotherapy was used in younger women, and those with greater disease burden. Earlier initiation of end-of-life discussions may be targeted to such patients.
在生命的最后几周停止化疗可能是护理质量的一个重要基准。转移性乳腺癌患者接受临终化疗的比例尚无充分描述。我们旨在确定转移性乳腺癌患者临终化疗的使用情况及其决定因素。我们进行了一项回顾性队列研究，使用了一个前瞻性整理的转移性乳腺癌患者数据库，这些患者于2010年1月1日至2014年9月30日期间死亡。临终化疗（EOLC）的使用定义为在死亡前2周内接受化疗（EOLC2）以及在死亡前4周内接受化疗（EOLC4）。在死亡前最后4周未接受任何化疗的患者被归类为非EOLC。我们确定了274例转移性乳腺癌患者，其中28例接受了EOLC2（10.2%），62例接受了EOLC4（22.6%）。与非EOLC患者相比，接受EOLC4的患者更年轻，疾病负担更重。EOLC4组的患者接受的化疗疗程更多。在多变量分析中，转移性疾病时年龄较小以及涉及的转移器官系统数量较多是临终化疗使用的预测因素。我们队列中临终化疗的使用比例高于先前描述的情况。年轻女性以及疾病负担较重的女性使用的临终化疗更多。对于此类患者，可能需要更早开始临终讨论。
