Place of death and chemotherapy use at the end of life in colorectal cancer.

Abstract

e23006 Background: Over the last decades, new drugs and multidisciplinary treatment increased the therapeutic options for palliative treatment of colorectal cancer (CRC). It is unclear, whether these options led to a more aggressive therapy at the end of life. Methods: For this retrospective cohort trial, we identified all stage IV CRC patients who received their complete therapy at an university hospital in Germany and investigated the use of palliative chemotherapy at the end of life (EOL) and the place of death (POD). Results: Between 01/2002 and 12/2012, 245 patients were treated with palliative chemotherapy for stage IV CRC and were evaluable for duration of palliative chemotherapy and place of death. 21% of the patients received chemotherapy within the last 30 days and 9% within 14 days before death. Overall survival of patients with chemotherapy use within the last 30 days of life was significantly shorter compared to patients without chemotherapy in the last month of life (12 vs. 20 months, p = 0.02), duration of palliative chemotherapy was non-significantly shorter (11 vs. 15 months, p = 0.29). Chemotherapy use was significantly more frequent used within 30 days before death from 2009-2012 (24%) compared to 2002-2005 (17%), p = 0.001. 58% of patients died in their residence (at home or in a nursing home), 27% on a general hospital ward (GHW)/ intensive care unit (ICU) and 15% on a palliative care unit (PCU) or hospice. Patients ≥70 years died significantly more often in their residence (70% vs. 53%; p = 0.013). From 2002-2005 to 2010-2012, less patients died in a GHW or ICU of acute care hospitals (39% vs. 16%; p = 0.007). Patients with a distance of ≤45 minutes to our institution more often died at home and in a PCU, Patients with a short therapy-free interval before death more often died in a hospital, (with chemotherapy in the last 30 days: 38%, with chemotherapy in the last 14 days: 45%). Conclusions: Although chemotherapy use at the EOL increased over the decade, more patients were able to die at home. Older patients and patients living in an urban centre more often died at home indicating that conditions for home care have improved independent of the duration of chemotherapy. However, patients with chemotherapy use at the EOL more often die in hospital.