van Ingen, W.L.R. (Willemijn) (2020) H et gebruik van systeemtherapie binnen drie maanden voor overlijden; een evaluatie van zinnige zorg bij hematologische en oncologische patiënten. thesis, Medicine.
Full text available on request.Abstract
Introduction Anti-tumor therapy (ATT) is used to combat malignancies or to prevent disease progression and is currently a common used treatment. Best Supportive Care (BSC) is often not or inadequately explained and implemented late in the disease-course, while it is associated with a better quality of life in the end-of-life phase. In malignancies, initial treatment choice is extensively investigated, but there is less information about its re-evaluation during the (end of the) treatment process. Objective This retrospective study describes and analyzes the characteristics of oncological and hematological decedents who received ATT within three months before their death. Method Adult cancer patients who died in 2018 or in 2019 were included. Demographic, clinical, and therapeutic data were collected and analyzed. Results A total of 187 (63%) patients received ATT within three months before their death. The median age was 67 years (interquartile range 58 – 73). Patients were primarily treated with palliative intent for an oncological malignancy. Almost three quarters received parenteral ATT. Almost all patients had agreed on treatment limitations and had received information on BSC during their illness, except for five and six patients, respectively. About half of the patients received ATT in the last 30 days before death; 25% of the total cohort still received treatment in their last two weeks. Analysis showed that elderly patients (ρ correlation coefficient -0.198, P = 0.007), patients with hematological disease (P <0.001), patients with treatment limitations (P = 0.001), and patients with enteral ATT (P <0.001) had significantly fewer ATT-free days before passing away. The same applies for patients whose disease was not evaluated in their last treatment line compared to those having documented progressive disease (P = 0.002) and patients with poor performance status (PS) compared to better condition (P = 0.005). Men were treated longer than women (P = 0.007). Patients who were informed about BSC as a treatment option more than 90 days before their death, stopped ATT significantly earlier compared to patients who were informed within three months before their death (P = 0.013). Hematologists implemented BSC significantly closer (median 3 days, IQ range 1-11) to death than oncologists (median 11 days, IQ range 5-20, P <0.001). Conclusion ATT in cancer patients is continued (too) long. This trend is mainly found in hematological patients and conditionally less vital patients, as well as with ATT that is administered orally. Timely discussion of any treatment limitations and BSC in this small population suggests a positive effect on the number of days between the last disease-specific course and death. Keywords: palliative chemotherapy, end-of-life, best supportive care, end-of-life care, quality of life, decision making, cancer, oncology, AML, cost-effectiveness
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Dr. Wymenga, A.N.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 01 Nov 2023 12:37 |
| Last Modified: | 01 Nov 2023 12:37 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3720 |
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