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Aggressiveness of end-of-life cancer care: what happens in clinical practice?

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Abstract

Purpose

End-of-life cancer care varies widely, and very few centers evaluate it systematically. Our objective was to assess indicators of the aggressiveness of end-of-life cancer care in clinical practice.

Methods

An observational, longitudinal, and retrospective cohort study was conducted at a tertiary hospital. Eligible patients were at least 18 years old, had a solid tumor, were followed up by the Oncology Department, and had died because of cancer or associated complications during 2017. We used the criteria of Earle et al. (J Clin Oncol 21(6):1133–1138, 2003) to assess the aggressiveness of care. Multivariate logistic regression analyses were performed to characterize factors associated with aggressiveness of therapy.

Results

The study population comprised 684 patients. Eighty-eight patients (12.9%) received anti-cancer treatment during the last 14 days of their lives, and 62 patients (9.1%) started a new treatment line in the last 30 days. During the last month of life, 102 patients (14.9%) visited the ER, 80 patients (11.7%) were hospitalized more than once, and 26 (3.8%) were admitted to the ICU. A total of 326 patients (47.7%) died in the acute care unit. A total of 417 patients (61.0%) were followed by the Palliative Care Unit, and in 54 cases (13.0%), this care started during the last 3 days of life.

Conclusions

The use of anti-cancer therapies and health care services in our clinical practice, except for the ICU, did not meet the Earle criteria for high-quality care. Concerning hospice care, more than half of the patients received hospice services before death, although in some cases, this care started close to the time of death.

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Authors and Affiliations

  1. Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain

    Estela García-Martín, Vicente Escudero-Vilaplana, Roberto Collado-Borrell, Belén Marzal-Alfaro, Eva González-Haba & María Sanjurjo

  2. Medical Oncology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    Bárbara Fox, Ricardo González del Val & Miguel Martín

  3. Palliative Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    María Sánchez-Isac & María Luisa Solano-Garzón

  4. Homecare Support Department, Dirección Asistencial Sureste, Madrid, Spain

    José Manuel Cano-González, Nuria Pérez de Lucas, Ana Isabel Bravo-Guillén & Javier Valero-Salinas

Authors
  1. Estela García-Martín
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  2. Vicente Escudero-Vilaplana
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  3. Bárbara Fox
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  8. Ricardo González del Val
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  15. Miguel Martín
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Corresponding author

Correspondence to Vicente Escudero-Vilaplana.

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The study was performed according to the ethics committee of the participating hospital and the Helsinki Declaration.

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The authors declare that they have no conflict of interest

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García-Martín, E., Escudero-Vilaplana, V., Fox, B. et al. Aggressiveness of end-of-life cancer care: what happens in clinical practice?. Support Care Cancer 29, 3121–3127 (2021). https://doi.org/10.1007/s00520-020-05828-9

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  • DOI: https://doi.org/10.1007/s00520-020-05828-9

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