title: Reduced use of chemotherapy at the end of life in an integrated-care model of oncology and palliative care.
abstract: OBJECTIVE
  When there is little hope of a clinical benefit, too delayed a withdrawal from chemotherapy might be detrimental for a patient's quality of life. We evaluated appropriately timed cessation of chemotherapy in our Oncology Department after integration of a Supportive and Palliative Care Unit.
  
  
  METHODS
  We carried out a review of deceased patients in our department from January 2006 to December 2009. Activities of the Supportive and Palliative Care Unit started in late 2007. We analyzed the characteristics of patients near the end of life and chemotherapy use within 30 days of death as an aggressiveness of cure index.
  
  
  RESULTS
  During the considered period, 361 hospitalized patients died: 69 in 2006, 77 in 2007, 97 in 2008 and 118 in 2009; 102 never received chemotherapy. Sixty-one of the remaining 259 patients died within 30 days of the last drug administration. The percentage of patients receiving chemotherapy in their last 30 days fell from 19% in 2006 and 20% in 2007, to 16% in 2008 and 14% in 2009.
  
  
  CONCLUSIONS
  Supportive and Palliative Care Unit integration decreased chemotherapy use in the last 30 days of life. A careful evaluation of prognostic factors of advanced cancer patients and provision of appropriate supportive and palliative cares can reduce the use of futile anticancer chemotherapy and preserve a patient's qualify of life.
authors.affiliation: Oncology Department, Ospedale Sacro Cuore-Don Calabria, Negrar (VR), Italy. roberto.magarotto@sacrocuore.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Magarotto
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Lunardi
authors.forename: Francesca
authors.initials: F
authors.lastname: Coati
authors.forename: Paola
authors.initials: P
authors.lastname: Cassandrini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Picece
authors.forename: Silvia
authors.initials: S
authors.lastname: Ferrighi
authors.forename: Luciana
authors.initials: L
authors.lastname: Oliosi
authors.forename: Marco
authors.initials: M
authors.lastname: Venturini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008495:Medical Oncology / Q000592:standards / Q000639:trends*; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010166:Palliative Care / Q000592:standards / Q000639:trends*; D011788:Quality of Life; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards / Q000639:trends*
chemical_list: D000970:Antineoplastic Agents