Use of chemotherapy at the end of life in a Portuguese oncology center.
OBJECTIVE
Chemotherapy plays a major role in the treatment of cancer. However, it is sometimes thought of as being taken too far, being used in many cases close to death. The purpose of this study is to determine the proximity of chemotherapy use to the patient's death in our hospital.


METHODS
This study comprised the analysis of the charts of 1,064 patients aged over 16 years with solid tumors who died in 2002 and were treated at the Porto Section of the Portuguese Institute of Oncology.


RESULTS
Four hundred ten of the 1,064 patients (39%) underwent chemotherapy. Fifty-two percent of those that underwent chemotherapy did so in the last 6 months of their lives, 31% in the last 3 months, 13% in the last month, and 3% in the last week. In the context of the total cohort of 1,064, the percentages of those that underwent chemotherapy was 20, 12, 5, and 1%, respectively. By multivariate analysis, age <65 years, breast and lung cancers, and metastases were positively associated with chemotherapy; kidney cancer and comorbidity were associated with a lower probability of undergoing chemotherapy. Three hundred sixty-one patients (34%) were admitted to the palliative care unit of the hospital.


CONCLUSIONS
It was concluded that in this hospital, chemotherapy is not used as close to death as often as most professionals feel and the literature reports. There are various possible explanations for this discrepancy; one of them may be the influence of health care systems. It would be useful to see what is happening in other countries with different health care systems.
Gonçalves
José Ferraz
JF
Department of Medical Oncology, Portuguese Institute of Oncology, Porto, 4200-072, Portugal. ferrazg@netcabo.pt
Goyanes
Carmen
C
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D010166:Palliative Care / Q000379:methods*; D011174:Portugal / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012042:Registries; D013727:Terminal Care / Q000379:methods*
D000970:Antineoplastic Agents
J Clin Oncol. 1995 May;13(5):1255-64
7738630
J Clin Oncol. 2001 Mar 1;19(5):1266-74
11230467
Psychooncology. 1997 Mar;6(1):1-11
9126711
Chest. 2000 May;117(5):1239-46
10807806
BMJ. 2003 Jul 26;327(7408):195-8
12881260
J Clin Oncol. 2003 Sep 15;21(18):3488-94
12972525
Ann Intern Med. 2003 Apr 15;138(8):639-43
12693886
Lancet. 1998 Oct 31;352(9138):1413-8
9807987
J Clin Oncol. 1999 Oct;17(10):3188-94
10506617
Br J Cancer. 1995 Feb;71(2):366-70
7530988
BMJ. 1990 Jun 2;300(6737):1458-60
2379006
J Clin Oncol. 2006 Jul 20;24(21):3490-6
16849766
J Clin Oncol. 2004 Jan 15;22(2):315-21
14722041
Crit Rev Oncol Hematol. 2007 Mar;61(3):255-60
17098441
J Clin Oncol. 1997 Jun;15(6):2403-13
9196156
Tumori. 2005 Jan-Feb;91(1):104-5
15850019