Evaluating end-of-life chemotherapy for solid tumor and hematologic malignancy patients

Abstract

Despite guidelines, chemotherapy near end-of-life (EOL) remains common, particularly in hematologic malignancy (HM). Determinants of EOL chemotherapy for hospitalized cancer patients are not well elucidated. We performed a retrospective cross-sectional descriptive study of patients who died inpatient within two weeks of chemotherapy in 2012 and 2014. By chart review, we identified patient characteristics, estimated performance status, categorized cause of death, and abstracted clinical intent. We identified 102 patients; 65% with HM and 35% with SM. Amongst these patients, rates of ‘Do Not Resuscitate’ status at time of death (P=0.36) were similar; patients with SM were more likely to receive a palliative care consultation (OR=7.6; 95%CI: 2.4–24.3) and less likely to die in intensive care (ICU) (OR=0.17; 95%CI=0.04–0.6). Progression of disease was the most common cause of death in both groups; patients with SM had lower likelihood of dying from a treatment-related cause (OR=0.06; 95%CI=0.01–0.32). Chemotherapy was administered closer to death in HM, 5.6 ± 4.2 days, compared to SM, 8.0 ± 3.7 days (IRR=2.18; 95%CI=0.58–3.78). For patients with HM, documented clinical reasoning emphasized curative intent. The dichotomization of palliative and oncologic care may contribute to worse EOL outcomes, particularly for patients receiving curative intent therapies.