Evaluation of chemotherapy within last two weeks of life: Patterns of care.

Abstract

e17590 Background: The discontinuation of chemotherapy within the last two weeks of life is a vital Quality Oncology Practice Initiative (QOPI) assessment measure. In the last two weeks of life, continuation of chemotherapy may contribute to death rates as much as 20%. An aggressive approach to therapy may not be related to improved patient outcomes. We assess patterns in patient deaths and chemotherapy treatment at the end of life in the metastatic setting. Methods: Charts were collected and reviewed retrospectively between October 2009 and December 2012 from one, large QOPI certified, oncology/hematology group; that sees over 3500 new cancer patients per year at 14 locations along central Illinois. The receipt of chemotherapy within two weeks before patient expiration was identified from past billing charges. Results: A total of 5,560 patients died during the three year period. 154 (2.8%) patients received chemotherapy within two weeks of their expiration; median age was 67 years (range 42-89). By line of treatment, 48% of patients who received chemotherapy within the last two weeks of life were in their first line of therapy, with 44% of those patients having received only the first cycle. Only 14% of patients had received >3 lines of chemotherapy. By diagnosis, lung cancer had the highest number of patients treated in the last two weeks of life (29%). Conclusions: It is expected that deaths within two weeks of chemotherapy occur in heavily treated patients who are receiving multiple cycles of salvage chemotherapy regimens. At our center, we found that many of these patients died just after initiation of first line therapy. Moreover, patient death rates were observed to be much lower than what has been reported in other studies. This provides insight into the patterns of cancer care near the end of life. Better tools are needed to identify which patients are at higher risk of early death following initiation of chemotherapy when disease is diagnosed at an advanced stage.