Prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer.
Prevalence and determinants of end-of-life chemotherapy use in patients with metastatic breast cancer.
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DOI：
10.1111/tbj.12905
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Brufsky AM
中科院分区：
文献类型：
--
作者：
Mathew A;Achkar T;Abberbock S;Sandhu GS;Jacob ME;Villgran VD;Rosenzweig MQ;Puhalla S;Brufsky AM
在生命的最后几周停止化疗可能是一个重要的护理质量基准。转移性乳腺癌患者接受临终化疗的比例没有得到很好的描述。我们的目的是确定转移性乳腺癌患者生命结束时使用化疗的患病率和决定因素。使用2010年1月1日至2014年9月30日期间死亡的转移性乳腺癌患者的前瞻性整理数据库进行了一项回顾性队列研究。生命终末期化疗（EOLC）使用定义为死亡后2周内接受化疗（EOLC 2）和死亡后4周内接受化疗（EOLC 4）。在死亡前4周内未接受任何化疗的患者被归类为非EOLC。我们确定了274例转移性乳腺癌患者，其中28例接受了EOLC 2（10.2%），62例接受了EOLC 4（22.6%）。与非EOLC相比，接受EOLC 4的患者更年轻，疾病负担更大。EOLC 4组患者接受的化疗线数较多。在多变量分析中，发生转移性疾病的年龄较小和涉及的转移性器官系统数量较多是生命终期化疗使用的预测因素。在我们的队列中，使用临终化疗的患病率高于先前描述的。在年轻女性和疾病负担更大的女性中使用了更多的临终化疗。提前启动生命结束讨论可能针对此类患者。
Cessation of chemotherapy in the last few weeks of life could be an important quality of care benchmark. Proportion of metastatic breast cancer patients who receive end of life chemotherapy is not well described. We aimed to determine the prevalence and determinants of end of life chemotherapy use in patients with metastatic breast cancer. A retrospective cohort study using a prospectively collated database of patients with metastatic breast cancer who died between January 1, 2010 and September 30, 2014 was conducted. End of life chemotherapy (EOLC) use was defined as receipt of chemotherapy within 2 weeks of death (EOLC2), and receipt of chemotherapy within 4 weeks of death (EOLC4). Patients who did not receive any chemotherapy in the last 4 weeks before death were categorized as non-EOLC. We identified 274 patients with metastatic breast cancer, of whom 28 received EOLC2 (10.2%) and 62 received EOLC4 (22.6%). In comparison to non-EOLC, patients receiving EOLC4 were younger and had greater disease burden. Patients in EOLC4 group received more number of lines of chemotherapy. In a multivariable analysis, younger age at metastatic disease and greater number of metastatic organ systems involved were predictors of end of life chemotherapy use. Prevalence of the use of end of life chemotherapy in our cohort was higher than previously described. More end of life chemotherapy was used in younger women, and those with greater disease burden. Earlier initiation of end of life discussions may be targeted to such patients.
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