Is Breast Cancer Treatment in the End of Life Less Aggressive?

Abstract

There is overuse of palliative systemic therapy in the end of life of breast cancer patients, but the growing awareness of this practice and the emphasis put in quality of end of life care might be shifting this practice. We hypothesized we could observe: more implementation of palliative strategies; less administration of palliative systemic anti-cancer therapy and decreased aggressiveness of cancer care in the end of life. We characterized the shifting trends in use of palliative chemotherapy administration and palliative care approaches in different institutions and times. We selected women that died of breast cancer during six years, from 2007 to 2012, and were treated in a central acute care general hospital and compared it with the breast cancer patients that died in 2003 and were treated in a large cancer center. We analyzed a total of 232 patients: the more recent group has 114 women and the initial cohort has 118. We used descriptive statistics to characterize chemotherapy in the end of life and use of palliative care resources. We showed increased: referral to palliative care inpatient and outpatient teams,referral to outpatient pain clinics,use of palliative radiotherapy and deaths at hospices instead of at acute care hospitals. Chemotherapy is still prolonged until the end of life, notwithstanding we showed a decrease in such practice. Other indicators of agressiveness, namely hospital admissions, have also shown a decrease. We showed there is more integration of multidisciplinary palliative care and less aggressiveness in the treatment of breast cancer patients, namely, decreased use of palliative anti-cancer treatment and decreased acute care hospital admissions. Nonetheless, systemic chemotherapy is still used until too late and the integration of oncology and palliative medicine in the care of breast cancer patients in the end of life is lacking.