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Identification of factors associated with aggressive end-of-life antitumour treatment: retrospective study of 1282 patients with cancer
  1. Philippe Debourdeau1,
  2. Mohamed Belkacémi2,
  3. Guillaume Economos3,
  4. Eric Assénat4,
  5. Werner Hilgers5,
  6. Julie Coussirou6,
  7. Sfaya Kouidri Uzan7,
  8. Léa Vasquez7,
  9. Antoine Debourdeau4,
  10. Jean Pierre Daures2 and
  11. Sebastien Salas8
  1. 1Supportive care unit, Institut sainte Catherine, Avignon, Provence Alpes Côte d'Azur, France
  2. 2EA 2415, LBERC, Laboratoire de Biostatistiques, Epidémiologie et Recherche Clinique, Université Montpellier 1, Montpellier, Languedoc-Roussillon, France
  3. 3EA3738, Centre d'Investigation en Cancérologie de Lyon, Universite Claude Bernard Lyon 1, Pierre-Bénite, Auvergne-Rhône-Alpes, France
  4. 4Medical Oncology, Hospital Saint-Eloi, Montpellier, Languedoc-Roussillon, France
  5. 5Medical Oncology, Institut Sainte Catherine, Avignon, Provence-Alpes-Côte d'Azu, France
  6. 6Pharmacy, Institut Sainte Catherine, Avignon, Provence Alpes Côte d'Azur, France
  7. 7Department of Medical Information, Institut Sainte Catherine, Avignon, Provence-Alpes-Côte d'Azu, France
  8. 8Oncology, CHU Timone, Marseille, France
  1. Correspondence to Dr Philippe Debourdeau, Institut Sainte Catherine, Avignon, Provence-Alpes-Côte d'Azu, France; p.debourdeau{at}isc84.org

Abstract

Objective Antitumour treatment in the last 2 weeks of death (ATT-W2) and a new regimen of ATT within 30 days of death (NATT-M1) are considered as aggressive end-of-life (EOL) care. We aimed to assess factors associated with inappropriate use of antitumour treatment (ATT) at EOL.

Methods Data of patients with cancer who died in 2013, 2015, 2017 and 2019 in a single for-profit cancer centre were retrospectively analysed. ATT was divided into chemotherapy (CT), oral targeted therapy (OTT), hormonotherapy and immunotherapy (IMT).

Results A total of 1282 patients were included. NATT-M1 was given to 197 (15.37%) patients, and 167 (13.03%) had an ATT-W2. Patients with a performance status of <2 and treated with CT had more both ATT- W2 (OR=2.45, 95% CI 1.65 to 3.65, and OR=10.29, 95% CI 4.70 to 22.6, respectively) and NATT-M1 (OR=2.01, 95% CI 1.40 to 2.90, and OR=8.41, 95% CI 4.46 to 15.86). Predictive factors of a higher rate of ATT-W2 were treatment with OTT (OR=19.08, 95% CI 7.12 to 51.07), follow-up by a medical oncologist (OR=1.49, 95% CI 1.03 to 2.17), miscellaneous cancer (OR=3.50, 95% CI 1.13 to 10.85) and length of hospital stay before death of <13 days (OR=1.92, 95% CI 1.32 to 2.79). Urinary tract and male genital cancers received less ATT-W2 (OR=0.38, 95% CI 0.16 to 0.89, and OR=0.40, 95% CI 0.16 to 0.99) and patients treated by IMT or with age <69 years more NATT-M1 (OR=19.21, 95% CI 7.55 to 48.8, and OR=1.69, 95% CI 1.20 to 2.37). Patients followed up by the palliative care team (PCT) had fewer ATT-W2 and NATT-M1 (OR=0.49, 95% CI 0.35 to 0.71, and OR=0.42, 95% CI 0.30 to 0.58).

Conclusions Most recent ATT and access to a PCT follow-up are the two most important potentially modifiable factors associated with aggressive EOL in patients with cancer. Early integrated palliative oncology care could help to decrease futile ATT at EOL.

  • Cancer
  • End-of-life care

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Footnotes

  • Twitter @AntoineDebourd1

  • Contributors PD: designed the research, supervised data collection and analyses, and drafted the main manuscript. MB: handled statistical analysis plan development and statistical analyses, reviewed and approved the final manuscript. GE: reviewed data analyses, administrative and legal requirements, reviewed and approved the final manuscript. EA, WH, JC, SKU and LV: had significant involvement in the protocol development, performed data extraction, and reviewed and approved the final manuscript. JPD: codesigned the research, protocol development and data analyses. Reviewed and approved the final manuscript. SS: supervised the research, protocol development and data analyses, and reviewed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The local ethics committee approved this project on 12 April 2018.

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

  • Data availability statement Data are available upon reasonable request from the corresponding author.

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