Chemotherapy use in end-of-life digestive cancer patients: a retrospective AGEO observational study.

Aged Antineoplastic Agents / therapeutic use Gastrointestinal Neoplasms / drug therapy Humans Retrospective Studies Terminal Care
Aggressiveness of end-of-life care Digestive oncology End-of-life chemotherapy Palliative care Palliative care team

Journal

Clinics and research in hepatology and gastroenterology
ISSN: 2210-741X
Titre abrégé: Clin Res Hepatol Gastroenterol
Pays: France
ID NLM: 101553659

Informations de publication

Date de publication:
09 2021
Historique:
received: 03 12 2020
accepted: 05 04 2021
pubmed: 1 5 2021
medline: 26 2 2022
entrez: 30 4 2021
Statut: ppublish

Résumé

The use of chemotherapy (CT) near the end-of-life (EOL) is an important issue in oncology since it could degrade quality of life. CT near EOL is still poorly studied, with no dedicated study in gastrointestinal (GI) cancer patients. To analyze in GI cancer patients the factors associated with the use of CT within 3- and 1-month before patients' death. All consecutive patients who died from a GI cancer in 10 French tertiary care hospitals during 2014 were included in this retrospective study. Clinical, demographical and biological data were collected and compared between patients receiving or not CT within 3- and 1-month before death. Variables associated with overall survival (OS) was also determined using of univariate and multivariate analyses with a Cox model. Four hundred and thirty-seven patients with a metastatic GI cancer were included in this study. Among them, 293 pts (67.0%) received CT within 3-months before death, and 121 pts (27.7%) received CT within 1-month before death. Patients receiving CT within 3-months before death were significantly younger (median age: 65.5 vs 72.8 years, p < 0.0001), with a better PS (PS 0 or 1: 53.9 vs 29.3%, p < 0.0001) and a higher albumin level (median: 32.8 vs 31.0 g/L, p = 0.048). Similar results were found for CT within 1 month before death. Palliative care team intervention was less frequent in patients who received CT in their last month of life (39.7% vs 51.3%, p = 0.02). In multivariate analysis, median OS from diagnosis was shorter in the group receiving CT within 1-month before death (HR = 0.59; 95% CI [0.48-0.74]). In GI-cancer patients, CT is administered within 3- and 1-month before death, in two and one third of patients, respectively. Patients receiving CT within 1-month before death, had more aggressive disease with poor OS. Palliative care team intervention was associated with less administration of CT in the last month of life. These results highlight the need to better anticipate the time to stop CT treatment in the end-of-life and the importance of an active collaboration between oncology and palliative care teams.

Sections du résumé

BACKGROUND
The use of chemotherapy (CT) near the end-of-life (EOL) is an important issue in oncology since it could degrade quality of life. CT near EOL is still poorly studied, with no dedicated study in gastrointestinal (GI) cancer patients.
AIM
To analyze in GI cancer patients the factors associated with the use of CT within 3- and 1-month before patients' death.
METHODS AND PARTICIPANTS
All consecutive patients who died from a GI cancer in 10 French tertiary care hospitals during 2014 were included in this retrospective study. Clinical, demographical and biological data were collected and compared between patients receiving or not CT within 3- and 1-month before death. Variables associated with overall survival (OS) was also determined using of univariate and multivariate analyses with a Cox model.
RESULTS
Four hundred and thirty-seven patients with a metastatic GI cancer were included in this study. Among them, 293 pts (67.0%) received CT within 3-months before death, and 121 pts (27.7%) received CT within 1-month before death. Patients receiving CT within 3-months before death were significantly younger (median age: 65.5 vs 72.8 years, p < 0.0001), with a better PS (PS 0 or 1: 53.9 vs 29.3%, p < 0.0001) and a higher albumin level (median: 32.8 vs 31.0 g/L, p = 0.048). Similar results were found for CT within 1 month before death. Palliative care team intervention was less frequent in patients who received CT in their last month of life (39.7% vs 51.3%, p = 0.02). In multivariate analysis, median OS from diagnosis was shorter in the group receiving CT within 1-month before death (HR = 0.59; 95% CI [0.48-0.74]).
CONCLUSION
In GI-cancer patients, CT is administered within 3- and 1-month before death, in two and one third of patients, respectively. Patients receiving CT within 1-month before death, had more aggressive disease with poor OS. Palliative care team intervention was associated with less administration of CT in the last month of life. These results highlight the need to better anticipate the time to stop CT treatment in the end-of-life and the importance of an active collaboration between oncology and palliative care teams.

Identifiants

DOI: 10.1016/j.clinre.2021.101709 PMID: 33930588
pubmed: 33930588
pii: S2210-7401(21)00088-7
doi: 10.1016/j.clinre.2021.101709
pii:
doi:

Substances chimiques

Antineoplastic Agents 0

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

101709

Informations de copyright

Copyright © 2021 Elsevier Masson SAS. All rights reserved.

Auteurs

Alexandra Lapeyre-Prost (A)

Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.

Geraldine Perkins (G)

Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.

Marie Vallee (M)

Oncology Department, Poitiers University Hospital, Poitiers, France.

Astrid Pozet (A)

Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.

David Tougeron (D)

Gastroenterology Department, Poitiers University Hospital, Poitiers, France.

Marianne Maillet (M)

Department of Gastroenterology, St-Louis Hospital, AP-HP, Paris, France.

Christophe Locher (C)

Department of Gastroenterology, General Hospital of Meaux, Meaux, France.

Johann Dreanic (J)

Department of Gastroenterology, Cochin Hospital, AP-HP, Paris, France.

Jean-Louis Legoux (JL)

Department of Gastroenterology and Digestive Oncology, Centre Hospitalier Regional, Orléans, France.

Astrid Lièvre (A)

Department of Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France; Department of Gastroenterology, Rennes University Hospital, Rennes 1 University, Rennes, France.

Cedric Lecaille (C)

Department of Gastroenterology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France.

Jean-Marc Sabate (JM)

Department of Gastroenterology, Louis Mourier Hospital, AP-HP, Colombes, France.

Florence Mary (F)

Gastroenterology and Digestive Oncology, CHU Avicenne, AP-HP, Bobigny, France.

Franck Bonnetain (F)

Methodology and Quality of Life in Oncology Unit, INSERM U1098, University Hospital of Besançon, Besançon, France.

Hélène Jaulmes-Bouillot (H)

Palliative Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France.

Florence Behal (F)

Palliative Care Unit, Georges Pompidou European Hospital, AP-HP, Paris, France.

Bruno Landi (B)

Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France.

Julien Taieb (J)

Université de Paris, Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, AP-HP, Paris, France. Electronic address: jtaieb75@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Chemotherapy use in end-of-life digestive...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Antinéoplasiques › Chemotherapy use in end-of-life digestive...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Tumeurs gastro-intestinales › Chemotherapy use in end-of-life digestive...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Chemotherapy use in end-of-life digestive...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Chemotherapy use in end-of-life digestive...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins terminaux › Chemotherapy use in end-of-life digestive...