Reduced use of chemotherapy at the end of life in an integrated-care model of oncology and palliative care


Aims and Background. When there is little hope of a clinical benefit, too delayed a withdrawal fromchemotherapymight be detrimental for a patient’s quality of life.We evaluated appropriately timed cessation of chemotherapy in our Oncology Department after integration of a Supportive and Palliative Care Unit.
Methods.We carried out a review of deceased patients in our department from January 2006 to December 2009. Activities of the Supportive and Palliative Care Unit started in late 2007. We analyzed the characteristics of patients near the end of life and chemotherapy use within 30 days of death as an aggressiveness of cure index.
Results. During the considered period, 361 hospitalized patients died: 69 in 2006, 77 in 2007, 97 in 2008 and 118 in 2009; 102 never received chemotherapy. Sixty-one of the remaining 259 patients died within 30 days of the last drug administration. The percentage of patients receiving chemotherapy in their last 30 days fell from19% in 2006 and 20% in 2007, to 16% in 2008 and 14% in 2009.
Conclusions. Supportive and Palliative Care Unit integration decreased chemotherapy use in the last 30 days of life. A careful evaluation of prognostic factors of advanced cancer patients and provision of appropriate supportive and palliative cares can reduce the use of futile anticancer chemotherapy and preserve a patient’s qualify of life.

Tumori 2011; 97(5): 573 - 577




Roberto Magarotto, Gianluigi Lunardi, Francesca Coati, Paola Cassandrini, Vincenzo Picece, Silvia Ferrighi, Luciana Oliosi, Marco Venturini

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