Patterns of palliative chemotherapy administration in the last 30 days of life. (#322)
Administration of chemotherapy when a patient is unlikely to survive longer than 30 days does not usually improve quality of life, or survival, unless the tumour is relatively chemosensitive, such as breast, colorectal, ovarian and small cell lung cancer1. Due to the unpredictable natural history of patients with advanced malignancy, it is impossible to achieve a zero rate of chemotherapy near the end of life, without withholding palliative chemotherapy from patients who might benefit from it.
A retrospective review was undertaken of adult patients who received chemotherapy at the Calvary Mater Newcastle and its rural outreach unit, Manning Base Hospital, between 1st January 2009 and 31st December 2011. Seven medical oncologists treated 1132 patients with palliative chemotherapy during this period, of whom 755 had died by 25th July 2012. 144 patients died within 30 days of receiving palliative chemotherapy (12.7% of the palliative group), with a median survival after diagnosis of 10.7 months, compared with 9.2 months for those in the palliative chemotherapy group who died more than 30 days after their last dose of chemotherapy. 42 patients died within 30 days of being started on a new course of palliative chemotherapy, with a median survival from diagnosis of 5.7 months. The tumour types with the highest rate of death within 30 days were, in descending order, cancers of small intestine, biliary, melanoma, unknown primary and head and neck. The rates by treating physician varied between 5.6 and 20.9%.
The rate of death in this review is in line with published rates of 9-20%2. The tumour types treated most commonly in the last 30 days of life did not correlate with those with relatively high response rates. Treating clinician predicted for late use of chemotherapy. Median survival was shorter in the ≤30 days group. It is proposed that a standardized baseline rate be determined as a quality indicator, to allow comparisons between institutions.
- Nappa U, Lindqvist O, Rasmussen BH, Axelsson B. Palliative chemotherapy in the last month of life. Annals of Oncology 2011;22:2375-2380.
- Kao S, Shafiq J, Vardy J, Adams D. Use of chemotherapy at the end of life in oncology patients. Annals of Oncology 2009;20:1555-1559.