title: Chemotherapy Near the End of Life for Chinese Patients with Solid Malignancies.
abstract: There are increasing concerns about the negative impacts of chemotherapy near the end of life (EOL). There is discrepancy among different countries about its use, and little is known about the real-world situation in China.
  
  
  
  This retrospective study was conducted at six representative hospitals across China. Adult decedents with a record of advanced solid cancer and palliative chemotherapy were consecutively screened from 2010 through 2014. The prevalence of EOL chemotherapy within the last 1 month of life was set as the primary outcome. The correlations among EOL chemotherapy, clinicopathological features, and overall survival (OS) were investigated.
  
  
  
  A total of 3,350 decedents who had had cancer were consecutively included; 2,098 (62.6%) were male and the median age was 56 years (range, 20-88). There were 177 (5.3%), 387 (11.6%), and 837 (25.0%) patients who received EOL chemotherapy within the last 2 weeks, 1 month, and 2 months of life, respectively. We identified inferior OS (median OS, 7.1 vs. 14.2 months; hazard ratio, 1.37; 95% confidence interval [CI], 1.23-1.53; p < .001), more intensive treatments (e.g., admitted to intensive care unit [ICU] in the last month of life, received cardiopulmonary resuscitation and invasive ventilation support), and hospital death (odds ratio, 1.53; 95% CI, 1.14-2.06; p = .005) among patients who received continued chemotherapy within the last month compared with those who did not. However, subgroup analyses indicated that receiving oral agents correlated with fewer ICU admissions and lower rates of in-hospital death.
  
  
  
  This study showed that EOL chemotherapy is commonly used in China. Intravenous chemotherapy at the EOL significantly correlated with poor outcomes and the role of oral anticancer agents warrants further investigation. The Oncologist 2017;22:53-60Implications for Practice: The role of chemotherapy toward the end of life (EOL) in patients with solid cancers is debatable. This article is believed to be the first to report the current prevalence of EOL chemotherapy in China. This study found that, compared with oral anticancer agents, intravenous chemotherapy at the EOL was significantly associated with poor outcomes. Therefore, the role of oral anticancer agents at the EOL stage deserves further investigation.
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Jin
authors: J
authors: Sheng
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Ya-Xiong
authors: YX
authors: Zhang
authors: Department of Radiotherapy, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China.
authors: Xiao-Bo
authors: XB
authors: He
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Wen-Feng
authors: WF
authors: Fang
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Yun-Peng
authors: YP
authors: Yang
authors: Department of Medical Oncology, Zhongshan City People's Hospital, Zhongshan, People's Republic of China.
authors: Gui-Nan
authors: GN
authors: Lin
authors: Department of Medical Oncology, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China.
authors: Xuan
authors: X
authors: Wu
authors: Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.|Henan Cancer Hospital, Zhengzhou, People's Republic of China.
authors: Ning
authors: N
authors: Li
authors: Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
authors: Jing
authors: J
authors: Zhang
authors: Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
authors: Lin-Zhu
authors: LZ
authors: Zhai
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Yuan-Yuan
authors: YY
authors: Zhao
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Yan
authors: Y
authors: Huang
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Ning-Ning
authors: NN
authors: Zhou
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Hong-Yun
authors: HY
authors: Zhao
authors: Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China zhangli@sysucc.org.cn.|State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.|Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China.
authors: Li
authors: L
authors: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011788:Quality of Life; D013727:Terminal Care
keywords: Advanced solid cancer; End‐of‐life; Palliative chemotherapy