Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status

Vitor Fiorin de Vasconcellos; Renata RCC Bonadio; Guilherme Avanço; Marcelo Vailati Negrão; Rachel Pimenta Riechelmann

doi:10.1186/s12904-019-0427-4

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Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status

Journal article

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Peer reviewed

Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status

Vitor Fiorin de Vasconcellos, Renata RCC Bonadio, Guilherme Avanço, Marcelo Vailati Negrão and Rachel Pimenta Riechelmann

BMC palliative care, Vol.18(1), 42

05/20/2019

DOI: 10.1186/s12904-019-0427-4

PMCID: PMC6528308

PMID: 31109330

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Abstract

The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC. We analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3-4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality. Two hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1-507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality. Patients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.

Adult

Aged

Brazil - epidemiology

Cohort Studies

Drug Therapy - methods

Drug Therapy - standards

Drug Therapy - statistics & numerical data

Female

Hospitalization - statistics & numerical data

Humans

Kaplan-Meier Estimate

Male

Middle Aged

Neoplasms - drug therapy

Neoplasms - epidemiology

Neoplasms - mortality

Palliative Care - methods

Palliative Care - standards

Palliative Care - statistics & numerical data

Proportional Hazards Models

Prospective Studies

Retrospective Studies

Survival Rate

Time Factors

Treatment Outcome

Details

Title: Subtitle: Inpatient palliative chemotherapy is associated with high mortality and aggressive end-of-life care in patients with advanced solid tumors and poor performance status
Creators: Vitor Fiorin de Vasconcellos - Instituto do Câncer do Estado de São Paulo
Renata RCC Bonadio - Instituto do Câncer do Estado de São Paulo
Guilherme Avanço - Instituto do Câncer do Estado de São Paulo
Marcelo Vailati Negrão - The University of Texas MD Anderson Cancer Center
Rachel Pimenta Riechelmann - Department of Clinical Oncology, AC Camargo Cancer Center, R. Prof. Antônio Prudente, 211 - Liberdade, São Paulo, SP, 01509-010, Brazil
Resource Type: Journal article
Publication Details: BMC palliative care, Vol.18(1), 42
DOI: 10.1186/s12904-019-0427-4
PMID: 31109330
PMCID: PMC6528308
NLM abbreviation: BMC Palliat Care
ISSN: 1472-684X
eISSN: 1472-684X
Language: English
Date published: 05/20/2019
Academic Unit: Internal Medicine
Record Identifier: 9984966789302771

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