title: Active treatment given in the last weeks of life: poor quality cancer care or justifiable behavior?
abstract: OBJECTIVE
  Chemotherapy near the end of life is frequently considered as an indicator of inappropriate aggressiveness. We were interested in revising our prescribing habits and in analyzing the reasons for offering active treatment to patients with advanced cancer.
  
  
  METHODS
  We examined the electronic medical records of all the cancer patients died in the Italian Region of Valle d'Aosta in a 1-year period and extracted all the available clinical data. From the 350 deceased patients, we selected the 141 to whom active treatment had been given during the natural history of their disease.
  
  
  RESULTS
  Among the patients undergoing any active treatment, the median number of days from the last administration to death was 75. Thirty-seven patients (26.2 %) had their last treatment administration during the 4 weeks before death and 20 (14.2 %) during the last 2 weeks. Fourteen patients (9.9 %) started treatment during the last 4 weeks. When the patients undergoing treatment in the last 4 weeks of life were compared with those subject to earlier withdrawal, only age and pretreatment were statistically significantly different. Most of the treatment choices were considered appropriate, and earlier treatment withdrawal could have been advised only in a minority of the cases.
  
  
  CONCLUSIONS
  Our data were at the lower range when compared with the available literature. Uncertainties in prognostication and the possibility of response to treatment can justify chemotherapy prescriptions in selected cases. We suggest that the focus should move to the provision of adequate and timely supportive care.
authors.affiliation: Department of Medical Oncology, U. Parini General Hospital, Viale Ginevra 3, 11100, Aosta, Italy, gnumico@ausl.vda.it.
authors.forename: Gianmauro
authors.initials: G
authors.lastname: Numico
authors.forename: Antonio
authors.initials: A
authors.lastname: Trogu
authors.forename: Antonella
authors.initials: A
authors.lastname: Cristofano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mozzicafreddo
authors.forename: Giulia
authors.initials: G
authors.lastname: Courthod
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Franco
authors.forename: Nicola
authors.initials: N
authors.lastname: Silvestris
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D011787:Quality of Health Care / Q000592:standards*; D013727:Terminal Care / Q000592:standards*