title: The aggressiveness of cancer care in the last three months of life: a retrospective single centre analysis.
abstract: BACKGROUND
  There is concern that terminally ill cancer patients are over treated with chemotherapy, even when such treatment is unlikely to palliate symptoms. The study objective was to evaluate the use of chemotherapy in the last three months of life in a cohort of adult patients with advanced solid tumours.
  
  
  METHODS
  All adult patients with solid tumours who died in our hospital in 2003 and received chemotherapy for advanced cancer, were included. Detailed data concerning chemotherapy and toxicity, in the last three months of life, were collected from patients' clinical charts.
  
  
  RESULTS
  A total of 319 patients were included. Median age was 61 years. Median time from diagnosis of metastatic disease to death was 11 months. The proportion of patients who received chemotherapy in the last three months of life was 66% (n = 211), in the last month 37% and in the last two weeks 21%. Among patients who received chemotherapy in the last three months of life, 50% started a new chemotherapy regimen in this period and 14% in the last month. There was an increased probability of receiving chemotherapy in the last three months of life in younger patients and in patients with breast, ovarian and pancreatic carcinomas.
  
  
  CONCLUSIONS
  There was a large proportion of patients who received chemotherapy in the last three months of life, including initiation of a new regimen within the last 30 days. Thus, further study is needed to evaluate if such aggressive attitude results in better palliation of symptoms at the end of life.
authors.affiliation: Instituto Português de Oncologia, Lisboa, Portugal. duarte_braga@hotmail.com
authors.forename: Sofia
authors.initials: S
authors.lastname: Braga
authors.forename: Ana
authors.initials: A
authors.lastname: Miranda
authors.forename: Rute
authors.initials: R
authors.lastname: Fonseca
authors.forename: J L
authors.initials: JL
authors.lastname: Passos-Coelho
authors.forename: Aires
authors.initials: A
authors.lastname: Fernandes
authors.forename: J D
authors.initials: JD
authors.lastname: Costa
authors.forename: António
authors.initials: A
authors.lastname: Moreira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D003710:Demography; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy*; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors