Clinical and Translational Oncology

, Volume 14, Issue 9, pp 667–674

Chemotherapy at the end of life: up until when?

Research Article



The aim of this study is to analyze the use of CT in terminal stage cancer and the percentage of patients who received UCPD in 2009 and 2010 on the Medical Oncology and Palliative Home Care integrated service (UCPD) ward of the Marqués de Valdecilla University Hospital.


Retrospective analysis of death rate registered on the Medical Oncology ward for 2009 and 2010 and the recorded date of the last CT given. The data are analyzed using the SPSS version 15.0 statistic package. Data were obtained from the Database Minimum Set for oncology admissions.


The death rate on the Medical Oncology ward is 22–24 %. Total number of cases studied is 303. 47 % of patients are aged 60 or younger. 81.8 % (248) received active cancer treatment; of these, 138 (55.6 %) in the last month, and 84 (33.8 %) in the last 2 weeks. Only 66 patients out of those who died on the ward (21 %) were previously sent to the UCPD.


Even when it is known that the majority of cancer patients become resistant to CT at the end of their lives, it is often given to patients of all ages. The request for palliative care is rare and often late.


Advanced cancer Palliative chemotherapy Palliative care Aggressive treatments End of life care 


  1. 1.
    Lorenz KA, Lynn J, Dy SM, Shugarman LR, Wilkinson A, Mularski RA et al (2008) Evidence for improving palliative care at the end of the life: a systematic review. Ann Intern Med 148:147–159PubMedGoogle Scholar
  2. 2.
    Ferlay J, Bray F, Pisani P, Parkin DM (2001) GLOBOCAN 20.00: cancer incidence, mortality and prevalence word wide. Version 1.0. IARC CancerBase N. 5.Lyon IARC PressGoogle Scholar
  3. 3.
    Natale RB, Zaretsky SusanL (2002) ZD1839 (Iressa™): what’s in it for the patient? Oncologist 7(suppl 4):25–30PubMedCrossRefGoogle Scholar
  4. 4.
    García Jordá E (2010) Cancer in Spain. Clin Transl Oncol 12:158–159PubMedCrossRefGoogle Scholar
  5. 5.
    Sanz-Ortiz J (2002) Oncología Médica y Cuidados Paliativos. Estudio de campo. VIII Congreso Nacional de Oncología Médica, 6–9 Octubre Hotel Meliá Valencia 2002. Libro de Ponencias: p 121; Sociedad Española de Oncología Médica (SEOM)Google Scholar
  6. 6.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ (2006) Cancer statistic 2006. CA Cancer J Clin 56:106–130PubMedCrossRefGoogle Scholar
  7. 7.
    Sanz-Ortiz J, Mayorga M, Martín Carnicero A (2010) La autopsia clínica en oncología: ¿está en crisis? Med Clin (Barc). doi:10.1016/j.medcli.2009.11.019
  8. 8.
    Sanz Ortiz J (2003) Nuevas dianas moleculares en la terapia del cáncer ¿Tienen función paliativa? Med Pal (Madrid) 10(4):220–225Google Scholar
  9. 9.
    Murillo RJ, Koeller J (2006) Chemotherapy given near the end or life by community oncologist for advanced non-small cell lung cancer. Oncologist 11:1095–1099PubMedCrossRefGoogle Scholar
  10. 10.
    Raby B, Pater J, Mackillop W (1995) Does knowledge guide practice? Another look at the management of non-small cell lung cancer. J Clin Oncol 13:1904–1911PubMedGoogle Scholar
  11. 11.
    Silvestri G, Pritchard R, Welch HG (1998) Preferences for chemotherapy in patients with non-small cell lung cancer: descriptive study based scripted interviews. BMJ 317:771–775PubMedCrossRefGoogle Scholar
  12. 12.
    Kean B, Oh D-Y, Lee S, 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. doi:10.1093/jjco/hym031 CrossRefGoogle Scholar
  13. 13.
    Earle CC, Landrum MB, Souza JM, Neville V, Weeks JC, Ayanian JZ et al (2008) Aggressiveness of cancer near the end of life: is it a quality-of-care issue? J Clin Oncol 26:3860–3866PubMedCrossRefGoogle Scholar
  14. 14.
    Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Vicki AJ, Constance MD, Craig DB, Juliet J, William FP, Andrew B, Thomas JL (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742PubMedCrossRefGoogle Scholar
  15. 15.
    Fundación ECO (Fundación para la Excelencia y la Calidad de la Oncología). Alerta de la incidencia de cáncer en menores de 65 años. Valencia 3 Febrero 2011. %20Dia %20Mundial %20Contra %20el %20Cancer %202011.pdf
  16. 16.
    GLOBOCAN 2008. (último acceso Marzo 2011)
  17. 17.
    Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Arlene SA (2003) Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med 138:639–643PubMedGoogle Scholar
  18. 18.
    Yun YH, Miyoung K, Sang Min P, Samyong K, Jong Soo C, Ho-Yeong L, Chang Geol L, Youn Seon C, Youn Seon H, Si-Young K, Dae Seog H (2007) Chemotherapy use and associated factors among cancer patients near the end of life. Oncology 72:164–171PubMedCrossRefGoogle Scholar
  19. 19.
    Hashimoto K, Yonemori K, Katsumata N, Hotchi M, Kouno T, Shimizu C, Tamura K, Ando M, Takeuchi M, Fujiwara Y (2009) Factors that affect the duration of the interval between the completion of palliative chemotherapy and death. Oncologist 14:752–759. Google Scholar
  20. 20.
    Sahm S, Will R, Hommel G (2005) What are cancer patients’ preferences about treatment at the end of life, and who should start talking about it? A comparison with healthy people and medical staff. Support Care Cancer 13:206–214PubMedCrossRefGoogle Scholar
  21. 21.
    Sánchez- Muñoz A, Pérez-Ruiz E, Sáez MI, Trigo JM, Galindo MM, Manzaneque L, Jiménez B, Muros B, Alba E (2011) Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status. Clin Transl Oncol 13(6):426–429PubMedCrossRefGoogle Scholar
  22. 22.
    Romaní Costa V, López E, Rodríguez Carballeira M, Almagro Mena P (2010) Morir en un hospital de agudos. Análisis de la situación de últimos días. Med Pal (Madrid) 17(4):222–225Google Scholar
  23. 23.
    NCCN Clinical Practice Guidelines in Oncology (2008) Palliative care V.1.2008. Standards of Palliative Care (Pal-1)Google Scholar
  24. 24.
    Huskamp HA, Keating NL, Malin JL, Zaslavsky AM, Weeks JC, Earle CC, Teno JM, Virnig BA, Kahn KL, He Y, Ayanian JZ (2009) Discussion with physicians about hospice among patients with metastatic lung cancer. Arch Intern Med 169:954–962PubMedCrossRefGoogle Scholar
  25. 25.
    Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC (2004) Trends in aggressiveness of cancer care the end of life. J Clin Oncol 22:315–321PubMedCrossRefGoogle Scholar
  26. 26.
    Malin JL (2004) Bridging the divide: integrating cancer-directed therapy and palliative care. J Clin Oncol 22:3438–3440PubMedCrossRefGoogle Scholar
  27. 27.
    National Consensus Project for Quality Palliative Care (2004) Clinical Practice Guidelines for quality palliative care.
  28. 28.
    Cherny NI, Portenoy NK (1994) Sedation in the management of refractory symptoms: guidelines for evaluation and treatment. J Palliat Care 10(2):31–38PubMedGoogle Scholar
  29. 29.
    Porta-Sales J, Núñez Olarte JM, Altisent Trota R, Bisbert Aguilar A, Loncan Vidal P, Muñoz Sánchez D et al (2002) Aspectos éticos de la sedación en cuidados paliativos. Med Pal (Madrid) 9(1):41–46Google Scholar
  30. 30.
    Doyle D (1992) Have we looked beyond the physical and psychosocial? J Pain Symptom Manag 7(5):302–311CrossRefGoogle Scholar
  31. 31.
    Sanz Ortiz J, Martín Carnicero A (2009) Desasosiego o “disconfortabilidad”: ¿un síntoma refractario en la fase final de la vida? Med Clin (Barc) 132(17):669–670CrossRefGoogle Scholar
  32. 32.
    Porta Sales J, Ylla-Catalá Boré A, Estibalez Gil I, Griman Malet A, Lafuerza Torres M, Nabal Vicuña C et al (1994) Estudio multicéntrico catalana-balear sobre la sedación Terminal en Cuidados Paliativos. Med Pal (Madrid) 6(4):153–158Google Scholar
  33. 33.
    Sulmasy DP, Pellegrino ED (1999) The rule of double effect: clearing up the double talk. Arch Intern Med 159:545–550PubMedCrossRefGoogle Scholar
  34. 34.
    Quill TE, Dresser R, Brock DW (1997) The rule of double effect a critique of its role in end-of-life decision making. N Engl J Med 337:1768–1771PubMedCrossRefGoogle Scholar
  35. 35.
    Sanz Ortiz J (2008) La sedación paliativa como lex artis en el cuidado del final de la vida. PSICOONCOLOGÍA 5(2–3):265–277Google Scholar
  36. 36.
    Alvarado-Cabrero I (2007) La autopsia: ¿ha muerto? Rev Med Mex Seguro Soc 45(1):1–2Google Scholar
  37. 37.
    Burton JL, Underwood J (2007) Clinical, educational, and epidemiological value of autopsy. Lancet 369(9571):1471–1480PubMedCrossRefGoogle Scholar
  38. 38.
    Petri CAN (1993) Decrease in the frequency of autopsies in Denmark after the introduction of a new Autopsy Act. Int J Qual Health Care 5:315–318CrossRefGoogle Scholar
  39. 39.
    Horowitz RE, Naritoku WY (2007) The autopsy as a performance measure and teaching tool. Human Pathol 38:688–695CrossRefGoogle Scholar
  40. 40.
    Skrabanek P (ed) (1999) La ideología de la salud. En: La muerte de la medicina con rostro humano. Diaz Santos S. A. Madrid, pp 1–35Google Scholar
  41. 41.
    Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA (2009) Effects of palliative care intervention on clinical outcomes in patients with advanced cancer. The project ENEABLE II Randomized Controlled Trial. JAMA 302(7):741–749PubMedCrossRefGoogle Scholar
  42. 42.
    Thomas JS, Bruce EH (2011) Bending the cost in cancer care. N Engl J Med 364(21):2060–2065CrossRefGoogle Scholar
  43. 43.
    Gómez- Batiste X, Tuca A, Porta-Sales J, Amor M, Espinosa J, Borrás JM, De la Mata I, Castellsagué J (2006) Resource consumption and cost of palliative care servicies in Spain: a multicenter prospective study. J Pain Symptom Manage 31(6):522–532PubMedCrossRefGoogle Scholar
  44. 44.
    Hui D, Elsayem A, De la Cruz M et al (2010) Availability an integration of palliative care at USS cancer centers. JAMA 303:1054–1061PubMedCrossRefGoogle Scholar
  45. 45.
    Dalal Sh, Palla Sh, Hui D, Li N, Chacko R, Li Zh, Fadul N, Scott Ch, Thorton V, Colman B, Amin Y, Bruera E et al (2011) Association between a name change from palliative to supportive care and the timing of patient referrals at a Comprehensive Cancer Center. Oncologist 16:105–111PubMedCrossRefGoogle Scholar
  46. 46.
    Sanz Ortiz J (2011) Quimioterapia en la fase final de la vida: ¿es compasiva? Med Clin (Barc) 136(8):343–344CrossRefGoogle Scholar
  47. 47.
    (1998) Cancer care during the last phase of life. ASCO SPECIAL ARTICLE. J Clin Oncol 16:1986–1996Google Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2012

Authors and Affiliations

  1. 1.Servicio de Oncología Médica y Cuidados Paliativos, Hospital Universitario Marqués de ValdecillaSantanderSpain

Personalised recommendations