Use of chemotherapy and immunotherapy in the last two months of life in a French institutional anticancer center, 2008-2009.

Abstract

e19656 Background: Despite improvements in the outcome of solid malignancy, a great number of patients (pts) will died from their affliction. The timing for cessation of oncologic treatment is difficult to establish. Furthermore, It would be useful, to have economic data of the end of life (EOL). This approach is rarely achieved in a French system of care. Methods: In order to collect data about therapy in the EOL and to understand the decision process, we performed a study in a French anticancer center. Results: From November 2008 to May 2009, we observed all adult pts treated in one single institution by at least one chemotherapy regimen for solid malignancy died from the evolution of disease, therapy-related complications or secondary neoplasm. 62 pts died in this period. Median age at death was 69. Colorectal (7), breast (8), lung (8) and head and neck (8) cancer were 50 % of the pts. Median time between diagnosis and death was 25.2 months. Median time between diagnosis of metastases and death was 11.4 months. Pts have received a median line of treatment of 2.5, 14 pts received 4 line or more. 54 pts died of terminal disease, although 8 pts died of acute complications. Among the 62 pts, 29% received chemotherapy or immunotherapy the last 4 wks and 48% the last 8 wks, corresponding to 726,22 € and 1566,37 € per treated pts. Among pts received therapy the last 8 wks, median time between last regimen and death was 13 days. As we found no toxic deaths, 2 pts died just after chemotherapy (3 and 1 days). We can estimate that 29% of the 62 pts had received a probably useless or nonevaluated therapy for efficacy, the last 4 wks. No predictive clinical factors have been found to understand the decision process. No correlation has been found between demographic characteristics of medical doctor and the decision process. 95% of pts have been informed of prognosis, in the last 4 wks. In 90% of pts, relatives and/or pts have been associated to decision of treatment. Conclusions: These preliminary data suggest, in EOL, the requirement to use evaluated clinical scale to indicate oncologic treatment, the need to evaluate toxic deaths, and to assess pertinence and efficacy of chemotherapy or biotherapy, including an economic approach. No significant financial relationships to disclose.