Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status.

Autor: Fiorin de Vasconcellos V; Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil. vitor.vasconcellos@gmail.com., Rcc Bonadio R; Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil., Avanço G; Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil., Negrão MV; Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP), Avenida Dr. Arnaldo, 251, Cerqueira César, São Paulo, 01246-000, Brazil.; Department of Thoracic/Head and Neck Medical Oncology, The University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 432, Houston, TX, 77030, USA., Pimenta Riechelmann R; Department of Clinical Oncology, AC Camargo Cancer Center, R. Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil.
Jazyk: angličtina
Zdroj: BMC palliative care [BMC Palliat Care] 2019 May 20; Vol. 18 (1), pp. 42. Date of Electronic Publication: 2019 May 20.
DOI: 10.1186/s12904-019-0427-4
Abstrakt: Background: The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC.
Methods: We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3-4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality.
Results: Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1-507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P <  0.001) were significantly associated with 30-day mortality.
Conclusions: Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.
Databáze: MEDLINE
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