Evaluating aggressiveness of end-of-life care in patients with advanced cancer: A retrospective single-center analysis

Abstract

Introduction Overuse of anti-cancer therapy near end of life is an important quality-of-care issue. An aggressive approach to treatment can have negative effects on the quality of life and cost of hospital-based resources. The objective of this study was to measure indicators of potential aggressiveness of end-of-life care in a cohort of adult patients with advanced solid tumor. The secondary objective was to analyze the association between clinicopathological variables and indicators of aggressiveness. Methods Retrospective data analysis was performed on adult patients with solid tumors who received palliative chemotherapy for advanced cancer and died in our hospital between 2017 and 2019. Indicators of aggressiveness of end of life care included chemotherapy use in the last days of life, emergency room visits and hospitalizations (including intensive care unit admissions) in this period, and referral to a palliative care unit before death. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy near end of life. Results Of the 571 patients included, 128 (22.4%) received chemotherapy within the last 2 weeks of life and 102 (17.8%) start a new chemotherapy regimen 30 days before death. During the last month of life, 168 patients (32.9%) visited emergency room more than once and 117 (20.5%) were hospitalized more than once. A total of 294 patients (51.5%) died in the acute care unit and 285 (49.9%) were referred to the palliative care unit. 24 of them (8.4%) died within 72h after referral. Conclusions The percentage of patients receiving chemotherapy near the end of life as well as the rate of emergency room visits and hospitalizations during this period are much higher than the value of the quality standard established in the literature. According to these indicators, cancer patient care at end of life can be considered overly aggressive. Optimization of palliative care at end of life is necessary.