The role of palliative care in the last month of life in elderly cancer patients.

Abstract

One major health care issue encountered in elderly cancer patients is the alteration of the quality of life. The purpose of our study is to evaluate the administration of chemotherapy in the last month of life (CLML) and to evaluate the impact of the palliative care consult (PCC) in the elderly patients. We conducted a retrospective observational study that included elderly patients diagnosed with an end-stage cancer and who were deceased between the 1st of January 2012 and the 31st of December 2015. Patient medical records were reviewed for patients' characteristics and management during the last month of life. This study enrolled 231 patients that fulfilled the eligibility criteria. CLML was administered in 91 patients (39.4%) among which 43 patients (47.3%) had their treatment within the last 2weeks of life. Seventy-seven patients (33.3%) had a palliative care consult (PCC) with a median duration of follow up of 13days (range 2-56days). Overall, PCC failed to decrease CLML administration, the duration of hospitalization, and ICU admissions. However, CLML administration decreased by 69% among patients that had their PCC before receiving treatment (OR=0.31; 95% CI 0.15-0.63). PCC also led to a change in the pattern of treatment administered in the last month of life with less cytotoxic therapy (OR=0.27 CI 95% 0.09-0.9, p=0.02) and higher rates of oral agents being prescribed (OR=3.8; 95% CI 1.3-11.3, p=0.014). Our elderly patients seem to receive aggressive management similar to the general oncology population. Early PCC was shown throughout our results to decrease the aggressiveness of cancer treatment in elderly patients which seems to improve the quality of care of our patients.