Windsor Regional Hospital, 2220 Kildare, WRCC, Windsor, ON, N8W 2X3, Canada.
London Health Sciences Center, Windsor, Canada.
BMC Palliat Care. 2022 Feb 7;21(1):20. doi: 10.1186/s12904-022-00910-x.
Chemotherapy use closer to the end of life is a marker of poor-quality care. There are now multiple studies and local reviews addressing this issue. Understanding the practice locally will give valuable insight and opportunity for improvement.
The study is a retrospective chart review of patients on chemotherapy at the Windsor Regional Cancer Center who died between April 1, 2016 to December 31, 2018. Information on demographics, type of cancer, type, intent and route of chemotherapy, line of chemotherapy, referral to hospice and palliative care services was collected.
A total of 681 patients on chemotherapy died between April 1, 2016 to Dec 13, 2018. Of these, 119 (17.4 %) died within 30 days following chemotherapy. Chemotherapy was parenteral (Intravenous and Subcutaneous) for the majority (75.2%) of the patients. Most (66.4%) of the patients died of disease progression. Intent for chemotherapy was palliative in 85% of patients, adjuvant/neoadjuvant in 6.6% and curative in 8.4% of the patients. Chemotherapy was 1, 2, 3 line or more in 67.4%, 21.3% and 11.3% of the patients respectively. The type of chemotherapy was conventional in 74.3% of patients and targeted/immunotherapy in 25.7% of patients. Of the variables studied, lack of palliative referral and having lung cancer or melanoma were significantly associated with higher risk of getting chemotherapy within the last 30 days of life. The odds of getting chemotherapy within the last 30 days of life was 0.35, 95% CI (0.24-0.53), P <0.001 for those who were referred to palliative care. On the other hand, the odds of getting chemotherapy were 4.18, 95% CI (1.17-13.71), P = 0.037 and 2.21, 95% CI (1.24-4.01), P = 0.037 for those with melanoma and lung cancer respectively. In addition, those with early referral to palliative care (90 days or more prior to death) were least likely to receive chemotherapy within the last 30 days of life.
Administration of chemotherapy within the last 30 days of life could cause unnecessary suffering to patients and cost to society. Early referral to palliative care was significantly associated with reduced risk of getting chemotherapy within the last 30 days of life in this study. Prospective study is recommended to further investigate the role of early palliative referral on use of chemotherapy during the last 30 days of life.
化疗在生命末期的使用是护理质量差的标志。现在有多项研究和本地审查都在解决这个问题。了解本地的做法将提供有价值的见解和改进的机会。
本研究是对温莎地区癌症中心 2016 年 4 月 1 日至 2018 年 12 月 31 日期间化疗后死亡的患者进行的回顾性图表审查。收集了人口统计学、癌症类型、化疗类型、意图和途径、化疗线数、临终关怀和姑息治疗服务的转诊信息。
在 2016 年 4 月 1 日至 2018 年 12 月 13 日期间，共有 681 名接受化疗的患者死亡。其中，119 人（17.4%）在化疗后 30 天内死亡。大多数（75.2%）患者接受的是静脉内和皮下化疗。大多数（66.4%）患者死于疾病进展。85%的患者化疗意图为姑息治疗，6.6%为辅助/新辅助治疗，8.4%为治愈治疗。67.4%、21.3%和 11.3%的患者分别接受了一线、二线和三线以上的化疗。74.3%的患者使用了常规化疗药物，25.7%的患者使用了靶向/免疫治疗药物。在所研究的变量中，缺乏姑息治疗转诊以及患有肺癌或黑色素瘤与在生命的最后 30 天内接受化疗的风险显著相关。在接受姑息治疗转诊的患者中，在生命的最后 30 天内接受化疗的可能性降低了 0.35，95%CI（0.24-0.53），P<0.001。另一方面，患有黑色素瘤和肺癌的患者接受化疗的可能性分别增加了 4.18，95%CI（1.17-13.71），P=0.037 和 2.21，95%CI（1.24-4.01），P=0.037。此外，在生命的最后 90 天或更早接受姑息治疗转诊的患者在生命的最后 30 天内接受化疗的可能性最小。
在生命的最后 30 天内给予化疗可能会给患者带来不必要的痛苦和社会成本。在这项研究中，早期向姑息治疗转诊与降低生命最后 30 天内接受化疗的风险显著相关。建议进行前瞻性研究，以进一步调查早期姑息治疗转诊对生命最后 30 天内化疗使用的影响。
