Palliative chemotherapy during the last month of life.

Abstract

e20662 Background: There is no uniform definition of medical futility, but most accept treatments offering no reasonable chance of benefiting patients will fall into this category. According to literature, chemotherapy given in the last month of life has little or no benefit to patients. Various studies suggest 9-43% of patients receive palliative chemotherapy during the last month of life. Methods: Retrospective analysis was done on electronic medical records of patients who received systemic anti cancer therapy (SACT) - cytotoxic and/or targeted therapy for solid or haematological malignancies at The Gold Coast hospital within one year period. Patients that died within 30 days of SACT administration were further classified based on their diagnosis, treatment intent, type of treatment and cause of death. Results: 770 patients received SACT between 1 November 2011 and 31 October 2012. 53 deaths (6.9%) occurred within 30 days of receiving SACT. 35 (66%) of those were due to progression of disease and 6 (11.3%) were treatment related. All treatment related deaths were due to neutropenic sepsis. For 12 deaths (22.7%), there was insufficient documentation to establish the cause of death. Only one patient with acute myeloid leukaemia (1.9%) died as a result of treatment given with curative intent. 20 patients (37.7%) were on combination treatment while 33 (62.3%) were treated with single agents. 42 patients (79.2%) received treatment that included intravenous agents, while remaining 11 patients (20.8%) were on oral treatment only. 37 patients (69.8%) were on cytotoxic treatment, 12 (22.6%) patients were on targeted therapy, and remaining 4 (7.6%) were on a combination protocol. Conclusions: Results of this audit show a lower number of patients who received palliative chemotherapy in a metropolitan public hospital in Australia during the last month of life. Defining the goal of treatment and assessing functional status of patients regularly while on treatment may help identify deteriorating patients and could avoid medically futile treatment. [Table: see text]