title: Aggressiveness of cancer treatment in patients hospitalized in a supportive care unit.
abstract: OBJECTIVE
  This study aimed at determining the aggressiveness of chemotherapy (CT)in patients hospitalized in a supportive care unit (focusing on mortality, patient profiles, survival, readmissions, and CT near death).
  
  
  METHODS
  In a prospective cohort study, 247 consecutive patients were investigated at the admission (disease, treatments, oncologist's theoretical survival prognosis, internist's clinical global impression (CGI)). A 3-and 6-month follow-up was performed. Survival was assessed up to 3 years.
  
  
  RESULTS
  Various cancer diagnoses were represented in polymorbid patients. Since disease onset, 69.6 % had received a first line of CT only; 147 patients (59.5 %) had CT at the admission; median CGI was 3 (range = 0-10); and theoretical survival prognosis was <12 months in 65.2 %. In-hospital mortality rate was 21 %. Odds of receiving CT was inversely associated with age (OR for patients ≥ 71 years vs. patients <50 years 0.19; 95 % CI 0.06-0.65; p = 0.02) and number of previous CT lines (OR for patients with 2-4 lines vs. those with 1 line 0.14; 95 % CI 0.06-0.34; p = 0.000). In the multi-adjusted model, 6-month survival remained associated with CT at the admission (HR 1.86; 95 % CI 1.31-2.65; p = 0.001), CGI (per point HR 0.84; 95 % CI 0.73-0.96; p = 0.013), and theoretical survival prognosis (per category HR 0.53; 95 % CI 0.44-0.66; p = 0.000). Very few patients needed readmission related to CT's adverse effects. From admission and throughout follow-up, 24 patients (9.7 %) had received CT during their last 14 days of life.
  
  
  CONCLUSIONS
  This study showed that a supportive care program can benefit a heterogeneous population as it contributes to assess clinical risks and benefits of CT and prevent aggressive care near death.
authors: Department of Rehabilitation and Geriatrics, Division of General Medical Rehabilitation (SMIR-BS), Geneva University Hospitals, University of Geneva, 26, avenue Beau-Séjour, 1211, Geneva 14, Switzerland, christophe.luthy@hcuge.ch.
authors: C
authors: C
authors: Luthy
authors: A
authors: A
authors: Pugliesi
authors: E
authors: E
authors: Rapiti
authors: M
authors: M
authors: Kossovsky
authors: P Y
authors: PY
authors: Dietrich
authors: C
authors: C
authors: Cedraschi
authors: A F
authors: AF
authors: Allaz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult