Skip to main content

Advertisement

SpringerLink
Log in

Treatment of cancer patients in their last month of life: aimless chemotherapy

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

Abstract

Purpose

The use of chemotherapy in the last month of life (CLML) of cancer patients is considered an aggressive approach to be avoided. We examined the practice of CLML in Lebanese cancer patients, and we investigated patient and tumor characteristics that justify this practice. To our knowledge, this is the first study describing CLML of Middle Eastern patients with advanced cancer.

Methods

We conducted this study at Hotel-Dieu de France University Hospital (HDF), Lebanon. Cases eligible for this study were all individuals diagnosed with cancer who died at HDF between the 1st of January and the 31st of December 2014. Demographic and clinical characteristics of the patients were obtained from the hospital registration records. Data concerning the management plan, primary malignancy and stage, chemo-sensitivity, line, type, and timing of chemotherapy in the last month of life were also obtained.

Results

Among the 130 cancer patients who were enrolled, CLML was administered to a total of 55 patients (42.3 %), of whom 26 patients (50 %) received more than one cytotoxic drug. Oral drug was only given to 9 patients (16.4 %). Interestingly, CLML increased the risk of death in the last month of life (p = 0.02), yet progression of disease constituted the major cause of death in this subgroup (54.6 %). The only variable to have statistical significant correlation with CLML was performance status (p = 0.03). The type of tumor and recent diagnosis of less than 2 months were also correlated to CLML (p = 0.03 and 0.024, respectively).

Conclusion

The high percentage of patients receiving CLML underlines the difficulty of end-of-life discussions in patients from Middle Eastern societies. This is true in the context of a country with little availability of palliative care resources, where health policies should be more focused on incorporating palliative medicine in all medical strategies.

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. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC (2004) Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol Off J Am Soc Clin Oncol 22(2):315–321

    Article  Google Scholar 

  2. Braga S (2011) Why do our patients get chemotherapy until the end of life? Ann Oncol Off J Eur Soc Med Oncol 22(11):2345–2348

    Article  CAS  Google Scholar 

  3. Tanneberger S, Malavasi I, Mariano P, Pannuti F, Strocchi E (2002) Planning palliative or terminal care: the dilemma of doctors’ prognoses in terminally ill cancer patients. Ann Oncol Off J Eur Soc Med Oncol 13(8):1320–1322, author reply 1322–3

    Article  CAS  Google Scholar 

  4. Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM et al (2012) American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol Off J Am Soc Clin Oncol 30(14):1715–1724

    Article  Google Scholar 

  5. O’Brien MER, Borthwick A, Rigg A, Leary A, Assersohn L, Last K et al (2006) Mortality within 30 days of chemotherapy: a clinical governance benchmarking issue for oncology patients. Br J Cancer 95(12):1632–1636

    Article  PubMed Central  PubMed  Google Scholar 

  6. van Eechoud IJ, Piers RD, Van Camp S, Grypdonck M, Van Den Noortgate NJ, Deveugele M et al (2014) Perspectives of family members on planning end-of-life care for terminally ill and frail older people. J Pain Symptom Manag 47(5):876–886

    Article  Google Scholar 

  7. Jaul E, Zabari Y, Brodsky J (2014) Spiritual background and its association with the medical decision of, DNR at terminal life stages. Arch Gerontol Geriatr 58(1):25–29

    Article  PubMed  Google Scholar 

  8. Mack JW, Walling A, Dy S, Antonio ALM, Adams J, Keating NL et al (2015) Patient beliefs that chemotherapy may be curative and care received at the end of life among patients with metastatic lung and colorectal cancer. Cancer 121(11):1891–1897

    Article  PubMed  Google Scholar 

  9. Ajrouch KJ, Abdulrahim S, Antonucci TC (2015) Family relations and health over the life course. A Lebanese perspective. J Méd Liban 63(1):8–14

    PubMed  Google Scholar 

  10. Naifeh Khoury M (2008) Palliative care education in Lebanon: past endeavors and future outlook. J Méd Liban 56(2):83–85

    PubMed  Google Scholar 

  11. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R et al. (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer Oxf Engl 1990;45(2):228–47

  12. Lee HS, Chun KH, Moon D, yeon HK, Lee S, Lee S (2015) Trends in receiving chemotherapy for advanced cancer patients at the end of life. BMC Palliat Care [Internet]. [cited 2015 Aug 11];14. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365766/

  13. Doumit MAA, Abu-Saad Huijer H, Kelley JH (2007) The lived experience of Lebanese oncology patients receiving palliative care. Eur J Oncol Nurs 11(4):309–319

    Article  PubMed  Google Scholar 

  14. Hamadeh GN, Adib SM (1998) Cancer truth disclosure by Lebanese doctors. Soc Sci Med 47(9):1289–1294

    Article  CAS  PubMed  Google Scholar 

  15. Sanz Ortiz J (2012) Chemotherapy at the end of life: up until when? Clin Transl Oncol Off Publ Fed Span Oncol Soc Natl Cancer Inst Mex 14(9):667–674

    Google Scholar 

  16. Ho TH, Barbera L, Saskin R, Lu H, Neville BA, Earle CC (2011) Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. J Clin Oncol Off J Am Soc Clin Oncol 29(12):1587–1591

    Article  Google Scholar 

  17. Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL et al (2012) Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med 367(17):1616–1625

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Ahn DH, Bekaii-Saab T (2014) Ampullary cancer: an overview. Am Soc Clin Oncol Educ Book ASCO Am Soc Clin Oncol Meet. 112–5

  19. Mayrbäurl B, Giesinger JM, Burgstaller S, Piringer G, Holzner B, Thaler J (2015) Quality of life across chemotherapy lines in patients with advanced colorectal cancer: a prospective single-center observational study. Support Care Cancer Off J Multinatl Assoc Support Care Cancer

  20. Gilliam LAA, St Clair DK (2011) Chemotherapy-induced weakness and fatigue in skeletal muscle: the role of oxidative stress. Antioxid Redox Signal 15(9):2543–2563

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Liu G, Franssen E, Fitch MI, Warner E (1997) Patient preferences for oral versus intravenous palliative chemotherapy. J Clin Oncol Off J Am Soc Clin Oncol 15(1):110–115

    CAS  Google Scholar 

  22. Gandara DR, Gumerlock PH (2005) Epidermal growth factor receptor tyrosine kinase inhibitors plus chemotherapy: case closed or is the jury still out? J Clin Oncol 23(25):5856–5858

    Article  PubMed  Google Scholar 

  23. Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS et al (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol Off J Am Soc Clin Oncol 30(4):394–400

    Article  Google Scholar 

  24. Sezgin Goksu S, Gunduz S, Unal D, Uysal M, Arslan D, Tatlı AM et al (2014) Use of chemotherapy at the end of life in Turkey. BMC Palliat Care 13(1):51

    Article  PubMed Central  PubMed  Google Scholar 

  25. Kao S, Shafiq J, Vardy J, Adams D (2009) Use of chemotherapy at end of life in oncology patients. Ann Oncol Off J Eur Soc Med Oncol 20(9):1555–1559

    Article  CAS  Google Scholar 

  26. Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ. et al. (2015) Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. JAMA Oncol

  27. Mohammed AA, Al-Zahrani AS, Ghanem HM, Farooq MU, El Saify AM, El-Khatib HM (2015) End-of-life palliative chemotherapy: where do we stand? J Egypt Natl Cancer Inst 27(1):35–39

    Article  Google Scholar 

  28. Martoni AA, Tanneberger S, Mutri V (2007) Cancer chemotherapy near the end of life: the time has come to set guidelines for its appropriate use. Tumori 93(5):417–422

    PubMed  Google Scholar 

  29. Keam B, Oh D-Y, Lee S-H, Kim D-W, Kim MR, Im S-A et al (2008) Aggressiveness of cancer-care near the end-of-life in Korea. Jpn J Clin Oncol 38(5):381–386

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

    Tarek Assi, Elie El Rassy, Samer Tabchi, Toni Ibrahim, Ralph Chebib, Fadi El Karak, Fadi Farhat, Georges Chahine, Fadi Nasr, Marwan Ghosn & Joseph Kattan

  2. Department of Radiology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

    Tania Moussa

Authors
  1. Tarek Assi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elie El Rassy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samer Tabchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toni Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tania Moussa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ralph Chebib
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fadi El Karak
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fadi Farhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Georges Chahine
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fadi Nasr
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Marwan Ghosn
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Joseph Kattan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tarek Assi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Assi, T., El Rassy, E., Tabchi, S. et al. Treatment of cancer patients in their last month of life: aimless chemotherapy. Support Care Cancer 24, 1603–1608 (2016). https://doi.org/10.1007/s00520-015-2959-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-015-2959-3

Keywords

Search

Navigation