Scotto Giulia, Galatà Anna, Fruscio Robert, Besana Giulia, Landoni Fabio, Sgro Luca, Testi Alessandra, Borella Fulvio, Cormio Gennaro, Gianciotta Mariangela, Arezzo Francesca, Maiorano Brigida Anna, Baldoni Alessandra, Destefanis Marinella, Ventriglia Jole, Pignata Sandro, Chiari Rita, Azzolina Maria Carmen, Raimondo Ivano, Turinetto Margherita, Tuninetti Valentina, Di Maio Massimo, Valabrega Giorgio
Medical Oncology, ASL TO3 Ospedale degli Infermi, Rivoli, Torino, Italy.
Department of Oncology, University of Turin, Turin, Italy.
Front Oncol. 2025 Aug 6;15:1641758. doi: 10.3389/fonc.2025.1641758. eCollection 2025.
The European Society for Medical Oncology (ESMO) 2021 Guidelines contraindicate the administration of chemotherapy in the last month of patients' life. The main objective of this multicenter observational retrospective study was to calculate the time elapsed between the date of the last chemotherapy and the date of death of patients with ovarian cancer. The secondary objectives were to identify any factors associated with a greater probability of receiving chemotherapy in the end of life.
Ovarian cancer patients operated between 2010 and 2020 in the participant Italian centers were enrolled. Only deceased patients whose date of death and date of last chemotherapy were known were included.
603 women from 10 Italian centers were included. One patient out of four (25.7%) received chemotherapy in the last month of life. The median survival from the last chemotherapy was 66 days. Patients with a neutrophil/lymphocyte ratio ≥5, with high C-reactive protein at the start of the last line and patients dying in hospital compared to hospice/palliative care at home were more likely to undergo chemotherapy at the end of life (p<0.001, p=0.05 and p<0.001 respectively). Being treated in Northern Italy reduces the chance of receiving chemotherapy at the end of life in comparison with Center-South (p<0.001), as well as being enrolled in at least one clinical protocol (p=0.027).
The TO CARE/MITO 42 study is a snapshot of the Italian practice in which there are still disparities in the treatment of patients at the end of life. A prospective observational study could provide useful elements for early identification of patients who would not benefit from a further line.
欧洲医学肿瘤学会（ESMO）2021年指南指出，在患者生命的最后一个月禁忌进行化疗。这项多中心观察性回顾性研究的主要目的是计算卵巢癌患者最后一次化疗日期与死亡日期之间的时间间隔。次要目的是确定与临终时接受化疗可能性更大相关的任何因素。
纳入2010年至2020年在参与研究的意大利中心接受手术的卵巢癌患者。仅纳入已知死亡日期和最后一次化疗日期的已故患者。
纳入了来自10个意大利中心的603名女性。四分之一（25.7%）的患者在生命的最后一个月接受了化疗。最后一次化疗后的中位生存期为66天。中性粒细胞/淋巴细胞比值≥5、最后一线治疗开始时C反应蛋白水平高的患者，以及与在家中接受临终关怀/姑息治疗相比在医院死亡的患者，在临终时更有可能接受化疗（分别为p<0.001、p=0.05和p<0.001）。与意大利中南部相比，在意大利北部接受治疗会降低临终时接受化疗的几率（p<0.001），以及参与至少一项临床方案也会降低几率（p=0.027）。
TO CARE/MITO 42研究是意大利实践的一个缩影，其中在临终患者的治疗方面仍然存在差异。一项前瞻性观察性研究可为早期识别那些无法从进一步治疗中获益的患者提供有用信息。
