Use of palliative chemotherapy near the end of life: A retrospective cohort study

Abstract

Background: For patients with metastatic cancer, treatment with palliative chemotherapy can lead to more aggressive end-of-life (EOL) care. This retrospective study aimed to assess the time from the last chemotherapy treatment to death and investigate the variables associated with the delivery of palliative chemotherapy near the end of life. Methods: Data from patients who died from metastatic cancer after receiving palliative chemotherapy from April 2007 to June 2019 at the Department of Integrated Therapy of Fudan University, Shanghai Cancer Center were analyzed. Statistical analysis was performed to evaluate variables including the patient's age, Charlson comorbidities, caregivers, and the type of cancer. Results: A total of 605 patients were included in the analysis, of whom 335 (58.7%) were treated with palliative chemotherapy during their last year of life and 16.2% were treated in their last month of life. Treatment with palliative chemotherapy in the last month was independently associated with age (P<0.001). In the last year of life, treatment with palliative chemotherapy differed significantly according to caregivers and age (P<0.001). The interval between the last chemotherapy treatment and death was the shortest for patients whose caregivers were adult children or those aged ≤50 years. Conclusions: In this study, palliative chemotherapy was used to treat 58.7% of patients in their last year, and 16.2% of patients in their last month, which is in line with international recommendations. In the last month, palliative chemotherapy was independently associated with age (P<0.001), whereas patients were more likely to receive palliative chemotherapy in their last year if their caregivers were adult children or if they were aged ≤50 years. Significant variations in EOL treatment strategies were observed according to caregivers and patient age during the last year of life.