title: Use of chemotherapy at the end of life among Taiwanese cancer decedents, 2001-2006.
abstract: BACKGROUND
  The availability of new chemotherapeutic agents has lengthened the treatment timeline for advanced cancers and increases the likelihood of receiving chemotherapy near death. Use of chemotherapy near the end of life may not benefit cancer patients. However, no population-based study has examined the determinants for continuing chemotherapy at the end of life for all ages and cancer groups as well as for a whole country. This population-based study assessed the association between continuation of chemotherapy in the last month of life and patient demographics, disease characteristics, primary physician's specialty, hospital characteristics, and healthcare resource availability at the hospital and regional levels.
  
  
  METHODS
  Retrospective population-based cohort study using administrative data among 204 850 Taiwanese cancer decedents in 2001-2006.
  
  
  RESULTS
  Rates of continued chemotherapy in the last month of life for each study year were 17.5%, 17.4%, 17.3%, 19.0%, 20.0%, and 21.0%, respectively and have remained steady since 2001. Taiwanese cancer patients had greater odds for continuation of chemotherapy in the last month of life if they were male [adjusted odds ratio (AOR) 1.19, 95% confidence interval (CI) 1.13-1.25], younger, single [1.21 (1.09-1.35)], had lower comorbidity levels, were diagnosed with hematologic malignancies [1.90 (1.09-1.35)] and breast cancer [1.24 (1.08-1.43)], had metastatic disease [1.36 (1.27-1.46)], and survived < 1 year but longer than two months post-diagnosis. The odds for continued chemotherapy in patients' last month was significantly increased by being cared for by a medical oncologist [3.49 (3.04-3.99)] or in a teaching hospital [1.39 (1.11-1.74)] and with the highest intensity of total inpatient hospital beds [1.63 (0.99-2.68)], but was not influenced by regional healthcare resources (total hospital and hospice beds).
  
  
  CONCLUSIONS
  The relative risk for continuation of chemotherapy in the last month of life was determined by patient demographics and disease characteristics, physician specialty, and healthcare resources at the primary hospital level.
authors.affiliation: National Institute of Cancer Research, National Health Research Institutes, Zhunan, Taiwan.
authors.forename: Tsang-Wu
authors.initials: TW
authors.lastname: Liu
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Chang
authors.forename: Hung-Ming
authors.initials: HM
authors.lastname: Wang
authors.forename: Jen-Shi
authors.initials: JS
authors.lastname: Chen
authors.forename: Shin Lan
authors.initials: SL
authors.lastname: Koong
authors.forename: Shu Chun
authors.initials: SC
authors.lastname: Hsiao
authors.forename: Siew Tzuh
authors.initials: ST
authors.lastname: Tang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003695:Delivery of Health Care; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D058007:Physicians, Primary Care; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care
chemical_list: D000970:Antineoplastic Agents