Palliative Chemo for Terminal Cancer Linked to Death in ICU
(HealthDay News) — Terminally ill patients with cancer who receive chemotherapy at the end of life are at increased risk of dying in an intensive care unit (ICU) and receiving cardiopulmonary resuscitation (CPR) and/or mechanical ventilation, according to research published March 4 in BMJ.
Alexi A. Wright, MD, of Harvard Medical School in Boston, and colleagues conducted a secondary analysis of data from a prospective, longitudinal study of 386 patients with advanced cancer. The authors examined the associations between palliative chemotherapy, end-of-life care, and place of death.
The researchers found that 56% of terminally ill cancer patients were receiving palliative chemotherapy at the time of enrollment. Patients receiving chemotherapy had higher rates of CPR, mechanical ventilation, or both, in the last week of life (14 vs. 2%; adjusted risk difference, 10.5%; 95% confidence interval [CI], 5.0–15.5%) and late hospice referrals (54 vs. 37%; adjusted risk difference, 13.6%; 95% CI, 3.6–23.6%), but no difference in survival (hazard ratio, 1.11; 95% confidence interval, 0.90–1.38). Patients who received palliative chemotherapy were more likely to die in an ICU (11 vs. 2%; adjusted risk difference, 6.1%; 95% CI, 1.1–11.1 percent) and less likely to die at home (47 vs. 66%; adjusted risk difference, −10.8%; 95% CI, −1.0–−20.6%).
"Future work should explore how a decision to start chemotherapy, even many months before death, comes to be associated with how and where someone dies," writes the author of an accompanying editorial.