title: Is there any association between where patients spend the end of life and survival after anticancer treatment for gynecologic malignancy?
abstract: BACKGROUND
  It remains unknown whether the end-of-life (EOL) environment influences survival after anticancer treatment, particularly for gynecologic malignancy.
  
  
  OBJECTIVE
  The study's objective was to clarify whether the survival time varied depending on where patients spend the EOL.
  
  
  METHODS
  This retrospective study included patients who received initial oncologic treatment but died due to cancer recurrence and/or progression. The subjects were a cohort of 181 gynecologic malignant tumor cases in a single institution from 2002 to 2008. Measurement was of postcancer treatment survival (PCS), defined as the time interval between the last date of anticancer treatment after recurrence/progression and death from the disease, analyzed on stratification by type of supportive care or where patients spent the EOL.
  
  
  RESULTS
  The median survival time was 26.1 (1.0-306.4) months. The distribution of the carcinoma type was as follows: 28.7% of patients with cervical (N=52), 27.6% with endometrial (N=50), and 43.1% with ovarian (N=79) cancer. The median PCS was 13.3 weeks. Patients in the hospice/home care group showed a significantly more favorable PCS than those in the hospital group (log rank: P=0.029). On multivariate analysis, the age (<60 versus ≥60) and site of supportive care (hospital versus hospice/home care) retained their significance as independent prognostic factors of poor PCS (age: HR=0.679, 95% CI, 0.496-0.928, P=0.0151; site of supportive care: HR=0.704, 95% CI, 0.511-0.970, P=0.0319).
  
  
  CONCLUSIONS
  Our current data could be hypothesis generating; it is possible that the EOL environment is a crucial prognostic factor for survival after anticancer treatment.
authors.affiliation: 1 Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine , Nagoya, Japan .
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kajiyama
authors.forename: Fumi
authors.initials: F
authors.lastname: Utsumi
authors.forename: Makiko
authors.initials: M
authors.lastname: Higashi
authors.forename: Jun
authors.initials: J
authors.lastname: Sakata
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Sekiya
authors.forename: Mika
authors.initials: M
authors.lastname: Mizuno
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Umezu
authors.forename: Shiro
authors.initials: S
authors.lastname: Suzuki
authors.forename: Eiko
authors.initials: E
authors.lastname: Yamamoto
authors.forename: Hiroko
authors.initials: H
authors.lastname: Mitsui
authors.forename: Kaoru
authors.initials: K
authors.lastname: Niimi
authors.forename: Kiyosumi
authors.initials: K
authors.lastname: Shibata
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Kikkawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy / Q000401:mortality*; D006699:Home Care Services; D017051:Hospice Care; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D019452:Terminally Ill; D013997:Time Factors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents