Skip to main content

Advertisement

SpringerLink
Log in

Chemotherapy in patients with advanced pancreatic cancer: too close to death?

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

We evaluated the attitude in using chemotherapy near the end of life in advanced pancreatic adenocarcinoma (PAC). Clinical and laboratory parameters recorded at last chemotherapy administration were analyzed, in order to identify risk factors for imminent death.

Methods

Retrospective analysis of patients who underwent at least one line of palliative chemotherapy was made. Data concerning chemotherapy (regimens, lines, and date of last administration) were collected. Clinical and laboratory factors recorded at last chemotherapy administration were: performance status, presence of ascites, hemoglobin, white blood cell (WBC), platelets, total bilirubin, albumin, LDH, C-reactive protein (C-rp), and Ca 19.9.

Results

We analyzed 231 patients: males/females, 53/47 %; metastatic/locally advanced disease, 80/20 %; and median age, 66 years (range 32–85). All patients died due to disease progression. Median overall survival was 6.1 months (95 % CI 5.1–7.2). At the last chemotherapy delivery, performance status was 0–1 in 37 % and 2 in 63 %. Fifty-nine percent of patients received one chemotherapy line, while 32, 8, and 1 % had second-, third-, and fourth line, respectively. The interval between last chemotherapy administration and death was <4 weeks in 24 %, ≥4–12 in 47 %, and >12 in 29 %. Median survival from last chemotherapy to death was 7.5 weeks (95 % CI 6.7–8.4). In a univariate analysis, ascites, elevated WBC, bilirubin, LDH, C-rp and Ca 19.9, and reduced albumin were found to predict shorter survival; however, none of them remained significant in a multivariate analysis.

Conclusions

A significant proportion of patients with advanced PAC received chemotherapy within the last month of life. The clinical and laboratory parameters recorded at last chemotherapy delivery did not predict shorter survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. Cancer J Clin 60:277–300

    Article  Google Scholar 

  2. Sultana A, Smith CT, Cunningham D et al (2007) Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 25:2607–2615

    Article  PubMed  Google Scholar 

  3. Cherny NJ, Abernethy AP, Strasser F et al (2009) Improving the methodologic and ethical validity of best supportive care studies in oncology: lessons from a systematic review. J Clin Oncol 27:5476–5486

    Article  PubMed  Google Scholar 

  4. Burris HA 3rd, Moore MJ, Andersen J et al (1997) Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 15:2403–2413

    PubMed  CAS  Google Scholar 

  5. Conroy T, Desseigne F, Ychou M et al (2011) FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 364:1817–1825

    Article  PubMed  CAS  Google Scholar 

  6. Pelzer U, Schwaner I, Stieler J et al (2011) Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group. Eur J Cancer 47:1676–1681

    Article  PubMed  CAS  Google Scholar 

  7. Earle CC, Neville BA, Landrum MB et al (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315–321

    Article  PubMed  Google Scholar 

  8. Earle CC, Park ER, Lai B et al (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133–1138

    Article  PubMed  Google Scholar 

  9. Park JK, Yoon YB, Kim YT et al (2008) Survival and prognostic factors of unresectable pancreatic cancer. J Clin Gastroenterol 42:86–91

    Article  PubMed  Google Scholar 

  10. Nakachi K, Furuse J, Ishii H et al (2007) Prognostic factors in patients with gemcitabine-refractory pancreatic cancer. Jpn J Clin Oncol 37:114–120

    Article  PubMed  Google Scholar 

  11. Viganó A, Bruera E, Jhangri GS et al (2000) Clinical survival predictors in patients with advanced cancer. Arch Intern Med 160:861–868

    Article  PubMed  Google Scholar 

  12. Earle CC, Ayanian JZ (2006) Looking back from death: the value of retrospective studies of end-of-life care. J Clin Oncol 24:838–840

    Article  PubMed  Google Scholar 

  13. Näppä U, Lindqvist O, Rasmussen BH et al (2011) Palliative chemotherapy during the last month of life. Ann Oncol 11:2375–2380

    Article  Google Scholar 

  14. Emanuel EJ, Young-Xu Y, Levinsky NG et al (2003) Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med 138:639–643

    PubMed  Google Scholar 

  15. O'Brien ME, Borthwick A, Rigg A et al (2006) Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients. Br J Cancer 95:1632–1636

    Article  PubMed  Google Scholar 

  16. Andreis F, Rizzi A, Rota L et al (2011) Chemotherapy use at the end of life. A retrospective single centre experience analysis. Tumori 97:30–34

    PubMed  Google Scholar 

  17. Braga S, Miranda A, Fonseca R et al (2007) The aggressiveness of cancer care in the last three months of life: a retrospective single centre analysis. Psychooncology 16:863–868

    Article  PubMed  Google Scholar 

  18. Goncxalves J, Goyanes C (2008) Use of chemotherapy at the end of life in a Portuguese oncology center. Support Care Cancer 16:321–327

    Article  Google Scholar 

  19. Keam B, Oh DY, Lee SH et al (2008) Aggressiveness of cancer-care near the end-of-life in Korea. Jpn J Clin Oncol 38:381–386

    Article  PubMed  Google Scholar 

  20. Sheffield KM, Boyd CA, Kuo Y-F et al (2011) End-of-life care in Medicare beneficiaries dying with pancreatic cancer. Cancer 117:5003–5012

    Article  PubMed  Google Scholar 

  21. Behl D, Jatoi A (2010) What do oncologists say about chemotherapy at the very end of life? Results from a semiquantitative survey. J Palliat Med 13:831–835

    Article  PubMed  Google Scholar 

  22. Earle CC, Neville BA, Ladrum MB et al (2005) Evaluating claims-based indicators of the end-of-life cancer care. Int J Qual Health Care 17:505–509

    Article  PubMed  Google Scholar 

  23. Smith TJ, Dow LA, Virago E et al (2010) Giving honest information to patients with advanced cancer maintains hope. Oncology 24:521–525

    PubMed  Google Scholar 

  24. Helft PR (2005) Necessary collusion: prognostic communication with advanced cancer patients. J Clin Oncol 23:3146–3150

    Article  PubMed  Google Scholar 

  25. Matsuyama R, Reddy S, Smith TJ (2006) Why do patients choose chemotherapy near end of life? A review of the prospective of those facing death from cancer. J Clin Oncol 24:3490–3496

    Article  PubMed  Google Scholar 

  26. Christakis N, Lamont E (2000) Extent and determinants of error in doctors' prognoses. Br Med J 320:469–473

    Article  CAS  Google Scholar 

  27. Vigano A, Dorgan M, Buckingham J et al (2000) Survival prediction in terminal cancer patients: a systematic review of the medical literature. Palliat Med 14:363–374

    Article  PubMed  CAS  Google Scholar 

  28. Glare P, Virik K, Jones M et al (2003) A systematic review of physicians' survival predictions in terminally ill cancer patients. Br Med J 327:195–200

    Article  Google Scholar 

  29. Maguire P (1985) Barriers to psychological care of the dying. Br Med J (Clin Res Ed) 291:1711–1713

    Article  CAS  Google Scholar 

  30. Kao S, Shafiq J, Vardy J, Adams D (2009) Use of chemotherapy at end of life in oncology patients. Ann Oncol 20:1555–1559

    Article  PubMed  CAS  Google Scholar 

  31. Thorne SE, Bultz BD, Baile WF et al (2005) Is there a cost to poor communication in cancer care?: a critical review of the literature. Psychooncology 14:875–884

    Article  PubMed  Google Scholar 

  32. Maltoni M, Caraceni A, Brunelli C et al (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23:6240–6248

    Article  PubMed  Google Scholar 

  33. Hauser CA, Stockler MR, Tattersall MHN (2006) Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review. Support Care Cancer 14:999–1011

    Article  PubMed  Google Scholar 

  34. Hess V, Glimelius B, Grawe P et al (2008) CA 19-9 tumor marker response to chemotherapy in patients with pancreatic cancer enrolled in a randomized controlled trial. Lancet Oncol 9:132–138

    Article  PubMed  CAS  Google Scholar 

  35. Feliu J, Jiménez-Gordo AM, Madero R et al (2011) Development and validation of a prognostic nomogram for terminally ill cancer patients. J Natl Cancer Inst 103:1613–1620

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

There are no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Centre Pluridisciplinaire d’Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    M. Frigeri

  2. Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    S. De Dosso, K. Feuerlein, H. Neuenschwander & P. Saletti

  3. Instituto Oncologico Nacional, Panama City, Panama

    O. Castillo-Fernandez

Authors
  1. M. Frigeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. De Dosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Castillo-Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Feuerlein
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Neuenschwander
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Saletti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Saletti.

Additional information

This study was presented at ECCO ESMO 2011, Stockholm, poster presentation (abstr 6589).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Frigeri, M., De Dosso, S., Castillo-Fernandez, O. et al. Chemotherapy in patients with advanced pancreatic cancer: too close to death?. Support Care Cancer 21, 157–163 (2013). https://doi.org/10.1007/s00520-012-1505-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-012-1505-9

Keywords

Search

Navigation