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Interventions in hospitalised patients with cancer: the importance of impending death awareness
  1. Eric Cornelis Theodorus Geijteman1,2,
  2. Marcella van der Graaf1,
  3. Frederika E Witkamp1,3,
  4. Sanne van Norden1,
  5. Bruno H Stricker4,
  6. Carin C D van der Rijt1,5,
  7. Agnes van der Heide2 and
  8. Lia van Zuylen1
  1. 1 Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
  2. 2 Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
  3. 3 Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
  4. 4 Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  5. 5 Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
  1. Correspondence to Eric Cornelis Theodorus Geijteman, Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam 3000 CA, The Netherlands; e.geijteman{at}


Objectives Burdensome and futile interventions with the aim of prolonging life should be avoided in dying patients. However, current clinical practice has hardly been investigated.

We examined the number and type of diagnostic and therapeutic medical interventions in hospitalised patients with cancer in their last days of life. In addition, we investigated if physician awareness of impending death affected the use of these interventions.

Methods Questionnaire study and medical record study. Attending physicians of patients who died in a university hospital between January 2010 and June 2012 were asked whether they had been aware of the patient’s impending death. The use of diagnostic and therapeutic interventions and medications was assessed by studying patients’ charts. We included 131 patients.

Results In the last 72 and 24 hours of life, 59% and 24% of the patients received one or more diagnostic interventions, respectively. Therapeutic interventions were provided to 47% and 31%. In the last 24 hours of life, patients received on average 5.8 types of medication.

Awareness of a patient’s impending death was associated with a significant lower use of diagnostic interventions (48% vs 69% in the last 72 hours; 11% vs 37% in the last 24 hours) and several medications that potentially prolong life (eg, antibiotics and cardiovascular medication).

Conclusions Many patients with cancer who die in hospital receive diagnostic and therapeutic interventions in the last days of life of which their advantages are questionable. To improve end-of-life care, medical care should be adapted.

  • clinical decisions
  • end of life care
  • hospital care
  • prognosis
  • terminal care

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  • Contributors Conception or design of the work: ECTG, MvdG, FEW, CCDvdR, AvdH and LvZ. Data collection: ECTG, MvdG, FEW and SvN. Data analysis and interpretation: ECTG, BHS and AvdH. Drafting the article: ECTG, CCDvdR, AvdH and LvZ. All authors contributed to the critical revision of the article and final approval of the version to be published.

  • Funding Data collection was funded by the Erasmus MC Medical Research Committee.

  • Competing interests None declared.

  • Ethics approval Medical ethical research committee of the Erasmus University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.