Abstract 2658: Chemotherapy within last 30 days of life: differences between hematologic malignancy (HM) and solid tumor (ST) patients at a cancer hospital

Abstract

Abstract BACKGROUND Appropriately timed cessation of chemotherapy is a quality of care measure in the Quality Oncology Practice initiative (QOPITM) of the American Society of Clinical Oncology. Cancer therapy options are increasingly available to patients with advanced disease stages. Discussing realistic therapeutic goals is thus critical, to minimize futile and unnecessary medical interventions. A Do not Resuscitate (DNR) order is one indicator of such discussions. We evaluated the written DNR orders and chemotherapy use within 30 days prior to end of life among cancer patients who died during hospitalization at our institution. METHODS All adult cancer patients who died on the inpatient units of the M.D. Anderson Cancer Center and admitted from June, 2010 through March, 2011 were included. Patients’ demographic information, chemotherapies dispensed within 30 days end of life (hormonal therapy were excluded), and inpatient DNR order (defined as DNR order documented during the last inpatient admission when patients have a status of discharge as “dead”) were collected from the institution database. Chi-square tests were used to determine the association between categorical variables. Chemotherapy and its association with age, gender, race, number of comorbidities, cancer type, and cancer stage was determined by logistic regression. Odds ratios (OR) with 95% confidence interval (CI) were summarized and compared for different groups. All statistical significance defined as P value < 0.05. RESULTS We identified 656 patients aged 18 years and older who died during hospitalization: median age 59 years; 42% female; 45% had HM. Of the patients with HM who died in hospital, 66% had chemotherapy within the last 30 days of life, compared to 27% for ST (p < 0.01). Most patients had a written DNR order: 90% HM; 88% ST (p > 0.05). Patients with written DNR orders had similar chemotherapy use (44%) compared to patients without DNR orders (45%) (p > 0.05). Compared to ST (non-metastatic) as a baseline OR = 1.0, the ORs for treatment were: HM (relapse), OR =14.5 (95% CI, 5.6-37.4); HM (no relapse), OR = 11.5 (95% CI, 4.6-28.8); ST (metastatic), OR = 2.7 (95% CI, 1.1-4.5). Patient's age, gender, ethnicity, and number of co-morbidities were not significant factors influencing chemotherapy treatment during the end of life (all p>0.05). DISCUSSION A significant number of patients dying in our hospital have received treatment and are hospitalized at the end of life. The critical factors are not known, but it may be they have a strong attitude of “not giving up”. As therapeutic alternatives increase for all cancers, treatment planning goals appropriate to the specific cancer prognosis, including treatment risks and end of life care and choices, become very important. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2658. doi:1538-7445.AM2012-2658