May 2014
BMJ 2014 March. [Epub ahead of print]
Alexi A Wright, Baohui Zhang, Nancy L Keating, Jane C Weeks, Holly G Prigerson
This study investigated the relationship between chemotherapy in patients with metastatic cancer among terminally ill cancer patients (as identified by physicians) and subsequent intensive medical care and place of death. This was done by performing a secondary analysis of the end of life care of 386 patients with metastatic cancer from the USA, who died during a longitudinal study from 2002-2008. Cardiopulmonary resuscitation (CPR) and/or mechanical ventilation in the last week of life and patients’ place of death were recorded. Data about survival from study enrolment to death, late hospice referrals (≤1 week before death), and dying in preferred place of death were also collected. At study enrolment, 216 (56%) patients were receiving palliative chemotherapy which was a median of 4 months before they died. These patients were more likely to be younger, married, better educated and insured, as well as having better physical and psychological functioning compared with patients who were not receiving chemotherapy. They were also less likely to acknowledge that their illness was terminal and had a preference for life prolonging treatments. ,. Patients receiving chemotherapy at enrolment were seven times more likely to have CPR and/or mechanical ventilation in the last week of life as well as late hospice referrals, but there was no difference in survival. Patients receiving palliative chemotherapy were also less likely to die in their preferred place, were five times more likely to die in an intensive care unit and less likely to die at home, compared with those who were not.
Jason Boland