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Indian J Palliat Care. 2019 Oct-Dec;25(4):539-543. doi: 10.4103/IJPC.IJPC_59_19.

Aggressive Care at the End of Life; Where Are We?

Author information

1
Department of Medical Oncology, Faculty of Medicine, Zagazig University, Egypt.
2
Oncology Center, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
3
Department of Clinical Oncology, Zagazig University, Egypt.
4
Department of Clinical Oncology, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia.
5
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Suez Canal University, Egypt.

Abstract

Background:

Although, efforts to encourage palliative care only for terminal patients, aggressive end-of-life care (EOL) care still common for those probably to die shortly.

Aim:

Multicenter experiences to investigate where did we stand in this era?

Patients and Methods:

A retrospective study included patients with advanced solid tumors. The presence of one or more of the following indicators in the last month of life (LM) referred to aggressive EOL care: emergency department (ED) visits ≥ twice, admission to the hospital through ED, death in critical care units (CCUs), and palliative chemotherapy (PC) at the past 2 weeks before death.

Results:

A total of 435 patients, 51.5% were men with a median age of 62 years (range: 17-108), were included in the study. Most of the patients (89.2%) belonged to Group II; they had attended ED at least twice (60%), approximately 53% admitted to the hospital through ED, 31% received PC-LM with 41% of them had at the past 2 weeks before death, 13% died in the CCUs, and more than half of them (53%) survived <2 weeks. Kaplan-Meier estimator revealed that median survival was 30 days in Group I versus 13 days in Group II (odds ratio: 1.63; 95% confidence interval: 1.20-2.21; P = 0.002). The median survival was statistically significantly associated with PC-LM ≥14 days and the admission mode. There was no statistically significant association with age, sex, and primary cancer sites.

Conclusion:

The majority of our patients continue with anticancer treatments they possibly do not need and associated with poor survival.

KEYWORDS:

End-of-life care; palliative chemotherapy; the good death

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