Author of

• 11946

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  P2.24 - Poster Session 2 - Supportive Care (ID 157)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11962

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    P2.24-016 - Why do we treat lung cancer patients with chemotherapy until the end of life? (ID 1135)

    09:30 - 09:30  |  Author(s): M. Machado
    • Abstract

    Background
    We have previously characterized chemotherapy (CT) administration in the end of life (EOL) of solid tumor patients (pts) and found that close to 40% of them are treated with CT in the last month of life (LMOL). With this work we want to understand the reasons for CT administration in the EOL and chose lung cancer as a model.

    Methods
    We used a population of dead lung cancer pts that were treated by one oncologist in one hospital from 2004 to 2012. The oncologist was blinded to study design, data collection and analysis. We collected data retrospectively in the pt clinical charts and hospital electronic medical records. For group comparisons we used Chi square and Mann-Whitney tests and logistic regression for multivariate analysis.

    Results
    We identified 223 pts. The median age of the cohort was 65 years and 83% were males. The histology was NSCLC in 88% of the pts and the stage distribution was stage I or II in 6%, stage IIIA in 9%, stage IIIB in 23% and stage IV in 62%. The median survival of the cohort was 12 months. Of these, 190 pts were treated with CT, 74 (40%) in the LMOL and 50 (26%) in the last two weeks. Univariate analysis shows 11 variables significantly associated with CT administration in the LMOL: (1) dying in the hospital, (2) no asymptomatic interval after first therapeutic modality, (3) no opioid use, (4) less than 7 month survival, (5-6) progression to first and to last CT line, (7-8) worse performance status (PS) at first and at last CT line, (9) PS of 3 at last CT line, (10) having had less total time on CT and (11) having a low median duration of response to CT. In the logistic regression model, living less than 7 months, undergoing more than 3 lines of CT, dying in the hospital, no opioid use, progression to last CT line and PS of 3 at last CT line were considered predictors of CT administration in LMOL.

    Conclusion
    We show that CT administration in the EOL occurs in symptomatic pts that have short survival and chemoresistant disease. It is known that pts, families and society have unreasonable expectations on the efficacy of EOL CT and oncologists feel obliged to try to obtain disease control in poor PS pts with aggressive disease. Additionally, the subjective nature of the bond between oncologists, pts and families in the EOL is impossible to capture in this report.