title: Difference in the timing of cessation of palliative chemotherapy between patients with incurable cancer receiving therapy only in a local hospital and those transitioned from a tertiary medical center to a local hospital.
abstract: BACKGROUND
  It is important to know when to decide to end palliative chemotherapy (PC) for the quality of life of patients. However, there is currently no clear agreement on when to terminate PC.
  
  
  OBJECTIVE
  To determine whether the difference of the period between the completion of PC and death affects patients' trajectory of supportive care near end of life.
  
  
  METHODS
  This retrospective study included 52 adult patients with incurable cancer who had received PC and who were referred to our palliative care team and died in our local hospital between July 2011 and June 2014. Group A comprised patients who received anticancer therapy such as surgery and PC only in our hospital and eventually died there. Group B comprised patients who were transitioned to our hospital from tertiary medical centers after cessation of PC.
  
  
  RESULTS
  17 of 22 patients (77%) in Group A conveyed the intention of continuing PC in the first interview with a physician of the palliative care team, whereas 4 of 30 patients (13%) in Group B conveyed a similar intention. The patients in Group B stopped PC a median of 43 days earlier than did the patients in Group A (𝑃 < .0001).
  
  
  CONCLUSIONS
  These data showed that more patients in Group A wanted to continue PC and had a shorter interval between last PC and death. Change in the hospital where the patients are given supportive care might contribute to the cessation of futile PC at an appropriate time.
authors: Palliative Care Team and Department of Surgery, Chichibu Municipal Hospital, Chichibu, Saitama, Japan. kamiyama@omiya.jichi.ac.jp.
authors: Hidenori
authors: H
authors: Kamiyama
authors: Palliative Care Team, Chichibu Municipal Hospital, Chichibu, Saitama, Japan.
authors: Kimiko
authors: K
authors: Kurosawa
authors: Palliative Care Team, Chichibu Municipal Hospital, Chichibu, Saitama, Japan.
authors: Terumasa
authors: T
authors: Ozawa
authors: Palliative Care Team and Department of Internal Medicine, Chichibu Municipal Hospital, Chichibu, Saitama, Japan.
authors: Keiko
authors: K
authors: Kobayashi
authors: Department of Gastroenterological Oncology, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
authors: Kenji
authors: K
authors: Gonda
authors: Palliative Care Team and Department of Internal Medicine, Chichibu Municipal Hospital, Chichibu, Saitama, Japan.
authors: Masatoshi
authors: M
authors: Teshigawara
authors: Department of Internal Medicine, Fujisawa Shonandai Hospital, Fujisawa, Kanagawa, Japan.
authors: Akiko
authors: A
authors: Sato
authors: Division of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
authors: Ken-Ichi
authors: K
authors: Maekawa
authors: Department of Palliative Medicine, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Motohiro
authors: M
authors: Matoba
keywords: cessation of palliative chemotherapy; change of hospital of care; fear of abandonment; transition to a local hospital