Difference in the timing of cessation of palliative chemotherapy between patients with incurable cancer receiving therapy only in a local hospital and those transitioned from a tertiary medical center to a local hospital

Hidenori Kamiyama; Kimiko Kurosawa; Terumasa Ozawa; Keiko Kobayashi; Kenji Gonda; Masatoshi Teshigawara; Akiko Sato; Ken-Ichi Maekawa; Motohiro Matoba

doi:10.12788/jcso.0180

Difference in the timing of cessation of palliative chemotherapy between patients with incurable cancer receiving therapy only in a local hospital and those transitioned from a tertiary medical center to a local hospital

J Community Support Oncol. 2015 Nov;13(11):405-10. doi: 10.12788/jcso.0180.

Authors

Hidenori Kamiyama¹, Kimiko Kurosawa², Terumasa Ozawa², Keiko Kobayashi³, Kenji Gonda⁴, Masatoshi Teshigawara³, Akiko Sato⁵, Ken-Ichi Maekawa⁶, Motohiro Matoba⁷

Affiliations

¹ Palliative Care Team and Department of Surgery, Chichibu Municipal Hospital, Chichibu, Saitama, Japan. kamiyama@omiya.jichi.ac.jp.
² Palliative Care Team, Chichibu Municipal Hospital, Chichibu, Saitama, Japan.
³ Palliative Care Team and Department of Internal Medicine, Chichibu Municipal Hospital, Chichibu, Saitama, Japan.
⁴ Department of Gastroenterological Oncology, International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan.
⁵ Department of Internal Medicine, Fujisawa Shonandai Hospital, Fujisawa, Kanagawa, Japan.
⁶ Division of Hematology and Immunology, Kagoshima University Hospital, Kagoshima, Japan.
⁷ Department of Palliative Medicine, Aomori Prefectural Central Hospital, Aomori, Japan.

PMID: 26863021
DOI: 10.12788/jcso.0180

Abstract

Background: It is important to know when to decide to end palliative chemotherapy (PC) for the quality of life of patients. However, there is currently no clear agreement on when to terminate PC.

Objectives: To determine whether the difference of the period between the completion of PC and death affects patients' trajectory of supportive care near end of life.

Methods: This retrospective study included 52 adult patients with incurable cancer who had received PC and who were referred to our palliative care team and died in our local hospital between July 2011 and June 2014. Group A comprised patients who received anticancer therapy such as surgery and PC only in our hospital and eventually died there. Group B comprised patients who were transitioned to our hospital from tertiary medical centers after cessation of PC.

Results: 17 of 22 patients (77%) in Group A conveyed the intention of continuing PC in the first interview with a physician of the palliative care team, whereas 4 of 30 patients (13%) in Group B conveyed a similar intention. The patients in Group B stopped PC a median of 43 days earlier than did the patients in Group A (𝑃 < .0001).

Conclusions: These data showed that more patients in Group A wanted to continue PC and had a shorter interval between last PC and death. Change in the hospital where the patients are given supportive care might contribute to the cessation of futile PC at an appropriate time.

Keywords: cessation of palliative chemotherapy; change of hospital of care; fear of abandonment; transition to a local hospital.