Processes of discontinuing chemotherapy for metastatic non-small cell lung cancer at the end of life.
Processes of discontinuing chemotherapy for metastatic non-small cell lung cancer at the end of life.
复制标题
转移性非小细胞肺癌临终时停止化疗的过程。
DOI：
10.1200/jco.2014.32.31_suppl.96
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
J. Temel
中科院分区：
文献类型：
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作者：
J. Greer;Kelly E. Irwin;I. Lennes;V. Jackson;E. Park;D. Fujisawa;A. Wright;J. Temel
96背景：在濒临死亡时进行化疗被广泛认为是低质量的护理。这项研究的目的是描述停止化疗的过程，并检查它们与死亡前的时机、临终关怀转诊和晚期住院的关系。
方法
我们回顾了151名新诊断的转移性非小细胞肺癌(NSCLC)患者的电子健康记录，这些患者参与了一项早期姑息治疗的随机试验。对最终方案中的化疗进行了定性分析，确定了停药过程的类别。然后，我们定量地调查了停用过程类别的预测因素和结果。
结果
144名患者死亡，其中81人接受静脉化疗，48人接受口服化疗作为最终方案。确定了五个停止程序：最终决定；推迟决定(中断)；放射治疗中断；因住院而中断；没有决定。对于接受静脉化疗的患者，最终决定的频率最低(19.7%)，而因住院而中断的频率最高(27.2%)。不同的过程发生在死亡前显著不同的时间；通常临终关怀转诊发生在化疗停止几个月后。延迟的决定，或“休息”，发生在死亡前最长的时间间隔，但最终的决定导致最大的临终关怀利用率。在接受口服化疗的患者中，83.3%的患者将静脉注射改为口服作为他们的最终方案，有时是在临终关怀转诊期间甚至之后。
结论
转移性非小细胞肺癌患者通过不同的过程停止他们的最终化疗方案，这些过程在死亡前和随后的生命末期护理中的时间显著不同。
96 Background: Administration of chemotherapy close to death is widely recognized as poor quality care. The goals of this study were to describe the processes of how chemotherapy is discontinued and examine their relationships with timing before death, hospice referrals, and terminal hospitalizations.
METHODS
We reviewed electronic health records of a prospective cohort of 151 patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) who participated in a randomized trial of early palliative care. Chemotherapy treatment during the final regimen was qualitatively analyzed, identifying categories of discontinuation processes. We then quantitatively investigated predictors and outcomes of the discontinuation process categories.
RESULTS
144 patients had died, with 81 and 48 receiving intravenous (IV) and oral chemotherapy as final regimens, respectively. Five discontinuation processes were identified: definitive decisions; deferred decisions (breaks); disruptions for radiation therapy; disruptions due to hospitalizations; and no decisions. For patients receiving IV chemotherapy, definitive decisions were least frequent (19.7%), while disruptions due to hospitalizations were most frequent (27.2%). The different processes occurred at significantly different times before death; and often hospice referrals occurred months after chemotherapy discontinuation. Deferred decisions, or "breaks," occurred at the longest interval before death, but definitive decisions resulted in greatest hospice utilization. Among patients receiving oral chemotherapy, 83.3% were switched from IV to oral as their final regimen, sometimes concurrent with or even after hospice referral.
CONCLUSIONS
Patients with metastatic NSCLC stop their final chemotherapy regimen via different processes, which significantly vary in time before death and in subsequent end-of-life care.