title: Treatment of cancer patients in their last month of life: aimless chemotherapy.
abstract: OBJECTIVE
  The use of chemotherapy in the last month of life (CLML) of cancer patients is considered an aggressive approach to be avoided. We examined the practice of CLML in Lebanese cancer patients, and we investigated patient and tumor characteristics that justify this practice. To our knowledge, this is the first study describing CLML of Middle Eastern patients with advanced cancer.
  
  
  METHODS
  We conducted this study at Hotel-Dieu de France University Hospital (HDF), Lebanon. Cases eligible for this study were all individuals diagnosed with cancer who died at HDF between the 1st of January and the 31st of December 2014. Demographic and clinical characteristics of the patients were obtained from the hospital registration records. Data concerning the management plan, primary malignancy and stage, chemo-sensitivity, line, type, and timing of chemotherapy in the last month of life were also obtained.
  
  
  RESULTS
  Among the 130 cancer patients who were enrolled, CLML was administered to a total of 55 patients (42.3 %), of whom 26 patients (50 %) received more than one cytotoxic drug. Oral drug was only given to 9 patients (16.4 %). Interestingly, CLML increased the risk of death in the last month of life (p = 0.02), yet progression of disease constituted the major cause of death in this subgroup (54.6 %). The only variable to have statistical significant correlation with CLML was performance status (p = 0.03). The type of tumor and recent diagnosis of less than 2 months were also correlated to CLML (p = 0.03 and 0.024, respectively).
  
  
  CONCLUSIONS
  The high percentage of patients receiving CLML underlines the difficulty of end-of-life discussions in patients from Middle Eastern societies. This is true in the context of a country with little availability of palliative care resources, where health policies should be more focused on incorporating palliative medicine in all medical strategies.
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon. tarekassi@gmail.com.
authors.forename: Tarek
authors.initials: T
authors.lastname: Assi
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Elie
authors.initials: E
authors.lastname: El Rassy
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Samer
authors.initials: S
authors.lastname: Tabchi
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Toni
authors.initials: T
authors.lastname: Ibrahim
authors.affiliation: Department of Radiology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Tania
authors.initials: T
authors.lastname: Moussa
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Ralph
authors.initials: R
authors.lastname: Chebib
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: El Karak
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: Farhat
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Georges
authors.initials: G
authors.lastname: Chahine
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: Nasr
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghosn
authors.affiliation: Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kattan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards* / Q000706:statistics & numerical data
chemical_list: D000970:Antineoplastic Agents
keywords: CLML; Cancer; Chemotherapy; End of life; Middle Eastern; Palliative care