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Symptom Management and Supportive Care

Factors That Affect the Duration of the Interval Between the Completion of Palliative Chemotherapy and Death

^aBreast and Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan; ^bDivision of Biostatistics, School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan

Key Words. Palliative chemotherapy • Survival • Death • End-of-life • Best supportive care

Correspondence: Kan Yonemori, M.D., Breast and Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Telephone: 81-3-3542-2511; Fax: 81-3-542-3815; e-mail: kyonemor{at}ncc.go.jp

Received November 20, 2008; accepted for publication May 31, 2009; first published online in THE ONCOLOGIST Express on July 11, 2009.

Disclosures

Kenji Hashimoto: None; Kan Yonemori: None; Noriyuki Katsumata: None; Marika Hotchi: None; Tsutomu Kouno: None; Chikako Shimizu: None; Kenji Tamura: None; Masashi Ando: None; Masahiro Takeuchi: None; Yasuhiro Fujiwara: None.

Section editors Eduardo Bruera and Russell Portenoy have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Background. The purpose of this study was to identify factors that affect the duration of the interval between the completion of palliative chemotherapy and death.

Methods. We retrospectively analyzed 255 cases in which patients had received palliative chemotherapy in the medical oncology division and died during the period 2002–2006. Univariate and multivariate analyses were performed to identify factors that affected the duration of the interval between the completion of chemotherapy and death.

Results. There were 133 cases of breast cancer, 77 cases of gynecological cancer, 24 cases of primary unknown cancer, and 21 cases of other cancers. The median interval between the completion of chemotherapy and death was 100 days (range, 5–1,206 days). Thirty-two patients (12.6%) died within 30 days, and 82 patients (32.3%) died within 60 days. Fifty-eight (22.7%) patients were symptomatic when chemotherapy was started, and 205 patients (80.4%) were provided information about palliative care units at the start of chemotherapy. The factors associated with a short interval between the completion of chemotherapy and death (90 days) according to the univariate analysis were male sex, young age (45 years), attending physician, poor Eastern Cooperative Oncology Group performance status score (3 or 4), obvious symptoms, and not having been given information about palliative care units. The results of the multivariate analysis indicated that young patients (45 years) who had not been referred to a palliative care unit and who had symptoms survived for a significantly shorter time interval.

Conclusion. Young patients who were symptomatic tended to choose chemotherapy instead of entering a palliative care unit until the very near-the-end-of-life stage.