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Annals of Oncology Advance Access originally published online on May 25, 2009
Annals of Oncology 2009 20(9):1555-1559; doi:10.1093/annonc/mdp027
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

supportive care and palliative care

Use of chemotherapy at end of life in oncology patients

S. Kao1,2,3, J. Shafiq4, J. Vardy3 and D. Adams1,2,*

1 Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool
2 Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown
3 Sydney Cancer Centre, Concord
4 Collaboration for Cancer Outcomes Research & Evaluation, Liverpool Hospital, Liverpool, Australia

* Correspondence to: Dr D. Adams, Macarthur Cancer Therapy Centre, Campbelltown Hospital, PO Box 149, Campbelltown, NSW 2560, Australia. Tel: +612-46344300; Fax: +612-46344350; E-mail: rada6283{at}bigpond.net.au

Background: Appropriately timed cessation of chemotherapy is integral to patient's quality of life. We evaluate the use of and associated factors with chemotherapy at the end of life.

Methods: A review of deceased oncology patients treated with palliative intent from April 2005 over 2 years at two cancer centres was carried out. Chi-square tests of patient demographics, cancer and chemotherapy variables were carried out to determine associations with commencing chemotherapy and continuation within 2 and 4 weeks of death. Multivariate analyses were carried out with significant factors to determine their independent effect.

Results: Seven hundred and forty-seven patients died during this period; median age 67 years (range 20–96); female 44%. Three hundred and ninety-eight (53%) received chemotherapy: 18% and 8% within 4 and 2 weeks of death, respectively. Younger age (P < 0.01), cancer type (P < 0.01) and chemosensitivity of the tumour (P < 0.01) were predictors for commencing chemotherapy in multivariate analysis. Treating doctor predicted for chemotherapy in the 4 weeks before death (<0.05), but none of the variables predicted for chemotherapy in the last 2 weeks of life.

Conclusions: Younger age, tumour type and chemosensitivity are important predictors of patients receiving palliative chemotherapy. Individual clinician was the only predictor for continuing chemotherapy in the last 4 weeks of life.

Key words: end of life, palliative chemotherapy, Quality Oncology Practice Initiative

Received for publication November 20, 2008. Revision received January 18, 2009. Accepted for publication January 23, 2009.


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