title: Care of cancer patients at the end of life in a German university hospital: A retrospective observational study from 2014.
abstract: BACKGROUND
  Cancer care including aggressive treatment procedures during the last phase of life in patients with incurable cancer has increasingly come under scrutiny, while integrating specialist palliative care at an early stage is regarded as indication for high quality end-of-life patient care.
  
  
  OBJECTIVE
  To describe the demographic and clinical characteristics and the medical care provided at the end of life of cancer patients who died in a German university hospital.
  
  
  METHODS
  Retrospective cross-sectional study on the basis of anonymized hospital data for cancer patients who died in the Munich University Hospital in 2014. Descriptive analysis and multivariate logistic regression analyses for factors influencing the administration of aggressive treatment procedures at the end of life.
  
  
  RESULTS
  Overall, 532 cancer patients died. Mean age was 66.8 years, 58.5% were men. 110/532 (20.7%) decedents had hematologic malignancies and 422/532 (79.3%) a solid tumor. Patients underwent the following medical interventions in the last 7/30 days: chemotherapy (7.7%/38.3%), radiotherapy (2.6%/6.4%), resuscitation (8.5%/10.5%), surgery (15.2%/31.0%), renal replacement therapy (12.0%/16.9%), blood transfusions (21.2%/39.5%), CT scan (33.8%/60.9%). In comparison to patients with solid tumors, patients with hematologic malignancies were more likely to die in intensive care (25.4% vs. 49.1%; p = 0.001), and were also more likely to receive blood transfusions (OR 2.21; 95% CI, 1.36 to 3.58; p = 0.001) and renal replacement therapy (OR 2.65; 95% CI, 1.49 to 4.70; p = 0.001) in the last 7 days of life. Contact with the hospital palliative care team had been initiated in 161/532 patients (30.3%). In 87/161 cases (54.0%), the contact was initiated within the last week of the patient's life.
  
  
  CONCLUSIONS
  Overambitious treatments are still reality at the end of life in cancer patients in hospital but patients with solid tumors and hematologic malignancies have to be differentiated. More efforts are necessary for the timely inclusion of specialist palliative care.
authors.affiliation: Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Dasch
authors.affiliation: Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Helen
authors.initials: H
authors.lastname: Kalies
authors.affiliation: Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Berend
authors.initials: B
authors.lastname: Feddersen
authors.affiliation: Specialized Palliative Home Care, Districts of Berchtesgaden and Traunstein, Germany.
authors.forename: Caecilie
authors.initials: C
authors.lastname: Ruderer
authors.affiliation: Department of Internal Medicine III, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hiddemann
authors.affiliation: Department of Palliative Medicine, Munich University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany; D049674:History, 21st Century; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D013727:Terminal Care