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摘要
This study aimed at determining the aggressiveness of chemotherapy (CT)in patients hospitalized in a supportive care unit (focusing on mortality, patient profiles, survival, readmissions, and CT near death). In a prospective cohort study, 247 consecutive patients were investigated at the admission (disease, treatments, oncologist's theoretical survival prognosis, internist's clinical global impression (CGI)). A 3-and 6-month follow-upwas performed. Survival was assessed up to 3 years. Various cancer diagnoses were represented in polymorbid patients. Since disease onset, 69.6 % had received a first line of CT only; 147 patients (59.5 %) had CT at the admission; median CGI was 3 (range = 0-10); and theoretical survival prognosis was < 12 months in 65.2 %. In-hospitalmortality rate was 21 %. Odds of receiving CT was inversely associated with age (OR for patients a parts per thousand yen71 years vs. patients < 50 years 0.19; 95 % CI 0.06-0.65; p = 0.02) and number of previous CT lines (OR for patients with 2-4 lines vs. those with 1 line 0.14; 95 % CI 0.06-0.34; p = 0.000). In the multiadjusted model, 6-monthsurvival remained associated with CT at the admission (HR 1.86; 95 % CI 1.31-2.65; p = 0.001), CGI (per point HR 0.84; 95 % CI 0.73-0.96; p = 0.013), and theoretical survival prognosis (per category HR 0.53; 95 % CI 0.44-0.66; p = 0.000). Very few patients needed readmission related to CT's adverse effects. From admission and throughout follow-up, 24 patients (9.7 %) had received CT during their last 14 days of life. This study showed that a supportive care program can benefit a heterogeneous population as it contributes to assess clinical risks and benefits of CT and prevent aggressive care near death.
- 出版日期2015-2
