Chemotherapy use in end-of-life digestive cancer patients: a retrospective AGEO observational study.

Autor: Lapeyre-Prost A; Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France., Perkins G; Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France., Vallee M; Oncology Department, Poitiers University Hospital, Poitiers, France., Pozet A; Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France., Tougeron D; Gastroenterology Department, Poitiers University Hospital, Poitiers, France., Maillet M; Department of Gastroenterology, St-Louis Hospital, AP-HP, Paris, France., Locher C; Department of Gastroenterology, General Hospital of Meaux, Meaux, France., Dreanic J; Department of Gastroenterology, Cochin Hospital, AP-HP, Paris, France., Legoux JL; Department of Gastroenterology and Digestive Oncology, Centre Hospitalier Regional, Orléans, France., Lièvre A; Department of Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France; Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, Rennes, France., Lecaille C; Department of Gastroenterology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France., Sabate JM; Department of Gastroenterology, Louis Mourier Hospital, AP-HP, Colombes, France., Mary F; Gastroenterology and Digestive Oncology, CHU Avicenne, AP-HP, Bobigny, France., Bonnetain F; Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France., Jaulmes-Bouillot H; Palliative Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France., Behal F; Palliative Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France., Landi B; Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France., Taieb J; Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France. Electronic address: jtaieb75@gmail.com.
Jazyk: angličtina
Zdroj: Clinics and research in hepatology and gastroenterology [Clin Res Hepatol Gastroenterol] 2021 Sep; Vol. 45 (5), pp. 101709. Date of Electronic Publication: 2021 Apr 27.
DOI: 10.1016/j.clinre.2021.101709
Abstrakt: Background: The use of chemotherapy (CT) near the end-of-life (EOL) is an important issue in oncology since it could degrade quality of life. CT near EOL is still poorly studied, with no dedicated study in gastrointestinal (GI) cancer patients.
Aim: To analyze in GI cancer patients the factors associated with the use of CT within 3- and 1-month before patients' death.
Methods and Participants: All consecutive patients who died from a GI cancer in 10 French tertiary care hospitals during 2014 were included in this retrospective study. Clinical, demographical and biological data were collected and compared between patients receiving or not CT within 3- and 1-month before death. Variables associated with overall survival (OS) was also determined using of univariate and multivariate analyses with a Cox model.
Results: Four hundred and thirty-seven patients with a metastatic GI cancer were included in this study. Among them, 293 pts (67.0%) received CT within 3-months before death, and 121 pts (27.7%) received CT within 1-month before death. Patients receiving CT within 3-months before death were significantly younger (median age: 65.5 vs 72.8 years, p < 0.0001), with a better PS (PS 0 or 1: 53.9 vs 29.3%, p < 0.0001) and a higher albumin level (median: 32.8 vs 31.0 g/L, p = 0.048). Similar results were found for CT within 1 month before death. Palliative care team intervention was less frequent in patients who received CT in their last month of life (39.7% vs 51.3%, p = 0.02). In multivariate analysis, median OS from diagnosis was shorter in the group receiving CT within 1-month before death (HR = 0.59; 95% CI [0.48-0.74]).
Conclusion: In GI-cancer patients, CT is administered within 3- and 1-month before death, in two and one third of patients, respectively. Patients receiving CT within 1-month before death, had more aggressive disease with poor OS. Palliative care team intervention was associated with less administration of CT in the last month of life. These results highlight the need to better anticipate the time to stop CT treatment in the end-of-life and the importance of an active collaboration between oncology and palliative care teams.
(Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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