title: Psychological factors at early stage of treatment as predictors of receiving chemotherapy at the end of life.
abstract: BACKGROUND
  Administration of chemotherapy in the last 14 days of life is a widely recognized indicator of poor end-of-life (EOL) care. The current study aimed to investigate predictors of this outcome, focusing on patients' self-reported psychological symptoms.
  
  
  METHODS
  This is a secondary analysis of a randomized controlled trial that examined the efficacy of early palliative care integrated with standard oncology practice in patients with metastatic non-small cell lung cancer (NSCLC). We analyzed associations between receipt of chemotherapy within 14 days of death and demographic, clinical, and quality-of-life variables in the 125 patients who received chemotherapy in the course of their illness and died during the 50-month follow-up.
  
  
  RESULTS
  Twenty-five patients (20%) received chemotherapy within the last 14 days of their life. Among demographic and clinical variables, only route of chemotherapy was significantly associated with receipt of chemotherapy within 14 days of death (oral 34.1% vs. intravenous (i.v.) 12.3%, p < 0.05). In the subsample of participants who received i.v. chemotherapy as their last regimen, greater anxiety and depression and lower quality of life in emotional, social, and existential domains were associated with greater likelihood of receiving chemotherapy at the EOL. These associations were not observed in patients who received oral chemotherapy as their last regimen.
  
  
  CONCLUSIONS
  Anxiety, depression, and worse psychological quality of life at early stage of treatment may be associated with the receipt of i.v. chemotherapy at the EOL. Further research is needed to examine how these factors might influence decision-making about the discontinuation of chemotherapy at the EOL.
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.|Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujisawa
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: Lara
authors.initials: L
authors.lastname: Traeger
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: Inga T
authors.initials: IT
authors.lastname: Lennes
authors.affiliation: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Mimura
authors.affiliation: Massachusetts General Hospital Cancer Center, Boston, MA, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001007:Anxiety / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D003863:Depression / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010166:Palliative Care / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D013727:Terminal Care / Q000706:statistics & numerical data*
chemical_list: D000970:Antineoplastic Agents