Aggressiveness of end-of-life cancer care: what happens in clinical practice?
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ORIGINAL ARTICLE
Aggressiveness of end-of-life cancer care: what happens in clinical practice? Estela García-Martín 1 & Vicente Escudero-Vilaplana 1 & Bárbara Fox 2 & Roberto Collado-Borrell 1 & Belén Marzal-Alfaro 1 & María Sánchez-Isac 3 & María Luisa Solano-Garzón 3 & Ricardo González del Val 2 & José Manuel Cano-González 4 & Nuria Pérez de Lucas 4 & Ana Isabel Bravo-Guillén 4 & Javier Valero-Salinas 4 & Eva González-Haba 1 & María Sanjurjo 1 & Miguel Martín 2 Received: 23 June 2020 / Accepted: 13 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Aggressiveness . Cancer . End of life . Hospice . Palliative care
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05828-9) contains supplementary material, which is available to authorized users. * Vicente Escudero-Vilaplana [email protected] 1
Pharmacy Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo 46, 28007 Madrid, Spain
2
Medical Oncology Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
3
Palliative Department, Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
4
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