Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status
Abstract Background The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mort...
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | BMC Palliative Care |
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| Online Access: | http://link.springer.com/article/10.1186/s12904-019-0427-4 |
| _version_ | 1828394252563906560 |
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| author | Vitor Fiorin de Vasconcellos Renata RCC Bonadio Guilherme Avanço Marcelo Vailati Negrão Rachel Pimenta Riechelmann |
| author_facet | Vitor Fiorin de Vasconcellos Renata RCC Bonadio Guilherme Avanço Marcelo Vailati Negrão Rachel Pimenta Riechelmann |
| author_sort | Vitor Fiorin de Vasconcellos |
| collection | DOAJ |
| description | Abstract Background The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. Methods We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3–4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. Results Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1–507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. Conclusions Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients. |
| first_indexed | 2024-12-10T07:52:07Z |
| format | Article |
| id | doaj.art-ab21ea16824c4d279303b272ace3b1c4 |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-10T07:52:07Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-ab21ea16824c4d279303b272ace3b1c42022-12-22T01:57:00ZengBMCBMC Palliative Care1472-684X2019-05-011811810.1186/s12904-019-0427-4Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance statusVitor Fiorin de Vasconcellos0Renata RCC Bonadio1Guilherme Avanço2Marcelo Vailati Negrão3Rachel Pimenta Riechelmann4Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP)Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP)Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP)Medical Oncology Department, Instituto do Cancer do Estado de São Paulo (ICESP)Department of Clinical Oncology, AC Camargo Cancer CenterAbstract Background The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. Methods We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3–4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. Results Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1–507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. Conclusions Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.http://link.springer.com/article/10.1186/s12904-019-0427-4PalliativeChemotherapyMetastasisCancerHospitalizationMedical futility |
| spellingShingle | Vitor Fiorin de Vasconcellos Renata RCC Bonadio Guilherme Avanço Marcelo Vailati Negrão Rachel Pimenta Riechelmann Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status BMC Palliative Care Palliative Chemotherapy Metastasis Cancer Hospitalization Medical futility |
| title | Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status |
| title_full | Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status |
| title_fullStr | Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status |
| title_full_unstemmed | Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status |
| title_short | Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status |
| title_sort | inpatient palliative chemotherapy is associated with high mortality and aggressive end of life care in patients with advanced solid tumors and poor performance status |
| topic | Palliative Chemotherapy Metastasis Cancer Hospitalization Medical futility |
| url | http://link.springer.com/article/10.1186/s12904-019-0427-4 |
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