Administration of chemotherapy with palliative intent in the last 30 days of life: the balance between palliation and chemotherapy

Authors

  • N. Zdenkowski,

    Corresponding author
    1. Department of Medical Oncology, Mercy Hospice, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
    2. Hunter Cancer Research Alliance, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
    • Correspondence

      Nicholas Zdenkowski, Department of Medical Oncology, Calvary Mater Newcastle, Locked Bag no. 7, Hunter Regional Mail Centre, NSW 2310, Australia.

      Email: nicholas.zdenkowski@calvarymater.org.au

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  • J. Cavenagh,

    1. Department of Palliative Care, Mercy Hospice, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
    2. Hunter Cancer Research Alliance, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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  • Y. C. Ku,

    1. Hunter Cancer Research Alliance, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
    2. Clinical Systems Team, Information Technology and Telecommunication Department, Hunter New England Local Health District, Newcastle, New South Wales, Australia
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  • A. Bisquera,

    1. Hunter Cancer Research Alliance, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
    2. Clinical Research Design, IT and Statistical Support, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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  • A. Bonaventura

    1. Department of Medical Oncology, Mercy Hospice, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
    2. Hunter Cancer Research Alliance, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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  • These data have been presented in part, as an oral abstract, at the Combined International Psycho-Oncology Society/Clinical Oncology Society of Australia Annual Scientific Meeting, in Brisbane, Australia in 2012.
  • Funding: None.
  • Conflict of interest: None.

Abstract

Background

Appropriately timed cessation of chemotherapy is an important aspect of good quality palliative care. There is wide variation in the reported rates of chemotherapy administration within the last 30 days of life.

Aims

To identify predictors of death within 30 days of receiving palliative chemotherapy, and to propose a standard definition by which oncologists and cancer centres can be compared.

Methods

Patients who received palliative chemotherapy at a regional cancer centre and its rural outreach unit between 2009 and 2011 were included. An adjusted logistic regression model, including all variables, was fit to identify predictors of death within 30 days of receiving palliative chemotherapy.

Results

Over a 3-year period, 1131 patients received palliative chemotherapy, 138 (12%) died within 30 days of receiving palliative chemotherapy. Predictors of death within 30 days of palliative chemotherapy were: less than 30 days contact with palliative care (odds ratio 3.30 (95% confidence interval 2.04–5.34), P < 0.001) and male gender (odds ratio 2.02 (95% confidence interval 1.24–3.31), P = 0.0049), but treating clinician, tumour chemoresponsiveness, age, body mass index and survival from initial diagnosis were not.

Conclusion

Patients who received chemotherapy in the last 30 days of life were more likely to be male and have a shorter duration of palliative care team involvement. In this study, the observed rate of death within 30 days of chemotherapy is within the range of published data. It is recommended that a standard definition be used to benchmark medical oncology centres and individual oncologists, and to allow comparison over time.

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