title: Characterization of patients receiving palliative chemo- and radiotherapy during end of life at a regional cancer center in Norway.
abstract: BACKGROUND
  Many cancer patients receive chemotherapy and radiotherapy their last 30 days [end of life (EOL)]. The benefit is questionable and side effects are common. The aim of this study was to investigate what characterized the patients who received chemo- and radiotherapy during EOL, knowledge that might be used to improve practice.
  
  
  METHODS
  Patients dead from cancer in 2005 and 2009 were analyzed. Data were collected from hospital medical records. When performance status (PS) was not stated, PS was estimated from other information in the records. A Glasgow Prognostic Score (GPS) of 0, 1 or 2 was assessed from blood values (CRP and albumin). A higher score is associated with a shorter prognosis.
  
  
  RESULTS
  In total 616 patients died in 2005; 599 in 2009. Among the 723 analyzed, median age was 71; 42% had metastases at diagnosis (synchronous metastases); 53% had PS 2 and 16% PS 3-4 at the start of last cancer therapy. GPS at the start of last cancer therapy was assessable in 70%; of these, 26% had GPS 1 and 35% GPS 2. Overall, 10% received chemotherapy and 8% radiotherapy during EOL. The proportions varied significantly between the different types of cancer. Multivariate analyses revealed that those at age<70 years, GPS 2, no contact with our Palliative Care Unit and synchronous metastases received most chemotherapy the last 30 days. PS 3-4, GPS 2 and synchronous metastases were strongest associated with radiotherapy the last 30 days.
  
  
  CONCLUSIONS
  Ten percent received chemotherapy and 8% radiotherapy the last 30 days of life. GPS 2 and synchronous metastases were most significantly associated with cancer therapy the last 30 days of life, indicating that in general, patients with the shortest survival time after diagnosis of cancer received more chemo- and radiotherapy during EOL than other patients.
authors.affiliation: European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway.
authors.forename: Malin
authors.initials: M
authors.lastname: Anshushaug
authors.forename: Mari Aas
authors.initials: MA
authors.lastname: Gynnild
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Anne
authors.initials: A
authors.lastname: Kvikstad
authors.forename: Bjørn H
authors.initials: BH
authors.lastname: Grønberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D002173:Cancer Care Facilities; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D009664:Norway / Q000453:epidemiology; D010166:Palliative Care / Q000706:statistics & numerical data*; D011379:Prognosis; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index
chemical_list: D000970:Antineoplastic Agents; D012709:Serum Albumin; D002097:C-Reactive Protein