Østfold Hospital Trust, Department of Oncology, Graalum, Norway; Oslo Metropolitan University, Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo, Norway.
Østfold Hospital Trust, Department of Oncology, Graalum, Norway.
Acta Oncol. 2024 May 8;63:313-321. doi: 10.2340/1651-226X.2024.22139.
A significant proportion of patients with incurable cancer receive systemic anticancer therapy (SACT) within their last 30 days of life (DOL). The treatment has questionable benefit, nevertheless is considered a quality indicator of end-of-life (EOL) care. This retrospective cohort study aims to investigate the rates and potential predictors of SACT and factors associated with SACT within the last 30 DOL. The study also evaluates the scope of Eastern Cooperative Oncology Group (ECOG) performance status and the modified Glasgow prognostic score (mGPS) as decision-making tools for oncologists.
This review of medical records included 383 patients with non-curable cancer who died between July 2018 and December 2019. Descriptive statistics with Chi-squared tests and regression analysis were used to identify factors associated with SACT within the last 30 DOL.
Fifty-seven (15%) patients received SACT within the last 30 DOL. SACT within 30 last DOL was associated with shorter time from diagnosis until death (median 234 days vs. 482, p = 0.008) and ECOG score < 3 30 days prior to death (p = 0.001). Patients receiving SACT during the last 30 DOL were more likely to be hospitalised and die in hospital. ECOG and mGPS score were stated at start last line of treatment only in 139 (51%) and 135 (49%) respectively.
Those with short time since diagnosis tended to receive SACT more frequently the last 30 DOL. The use of mGPS as a decision-making tool is modest, and there is lack in documentation of performance status.
相当一部分患有绝症的癌症患者在生命的最后 30 天内接受全身性抗癌治疗（SACT）。这种治疗的益处值得怀疑，但被认为是生命末期（EOL）护理的质量指标。本回顾性队列研究旨在调查 SACT 的发生率和潜在预测因素，以及生命最后 30 天内 SACT 的相关因素。该研究还评估了东部合作肿瘤学组（ECOG）表现状态和改良格拉斯哥预后评分（mGPS）作为肿瘤学家决策工具的范围。
本研究回顾了 2018 年 7 月至 2019 年 12 月期间死亡的 383 名非绝症癌症患者的病历。采用卡方检验和回归分析进行描述性统计，以确定与生命最后 30 天内 SACT 相关的因素。
57 名（15%）患者在生命最后 30 天内接受 SACT。生命最后 30 天内接受 SACT 与诊断后至死亡的时间较短（中位数分别为 234 天和 482 天，p=0.008）和死亡前 30 天 ECOG 评分<3 相关（p=0.001）。在生命最后 30 天内接受 SACT 的患者更有可能住院并在医院死亡。只有 139 名（51%）和 135 名（49%）患者在开始最后一线治疗时报告了 ECOG 和 mGPS 评分。
那些从诊断到死亡时间较短的患者在生命最后 30 天内更倾向于接受 SACT。mGPS 作为决策工具的使用量适中，且表现状态的记录缺乏。
