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Discrepancies in the use of chemotherapy and artificial nutrition near the end of life for hospitalised patients with metastatic gastric or oesophageal cancer. A countrywide, register-based study
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Number of Authors: 5
2017 (English)In: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 79, 31-40 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To evaluate the frequency and the factors associated with the use of chemotherapy and artificial nutrition near the end of life in hospitalised patients with metastatic oesophageal or gastric cancer.

Methods: Nationwide, register-based study, including all hospitalised adults (>= 20 years) who died with metastatic oesophageal or gastric cancer between 2010 and 2013, in France. Chemotherapy and artificial nutrition during the final weeks of life were considered as primary outcomes.

Results: A total of 4031 patients with oesophageal cancer and 10,423 patients with gastric cancer were included. While the proportion of patients receiving chemotherapy decreased from 35.9% during the 3rd month before death to 7.9% in the final week (p < 0.001 for trend), the use of artificial nutrition rose from 9.6% to 16.0% of patients. During the last week before death, patients with stomach cancer were more likely to receive chemotherapy (adjusted odds ratio (aOR) = 1.35, 95% CI = 1.17-1.56) but less likely to receive artificial nutrition (aOR = 0.80, 95% CI = 0.73-0.88) than patients with cancer of the oesophagus. The adjusted rates of chemotherapy use during the last week of life varied from 1.6% in rural hospitals to 11.2% in comprehensive cancer centres, while the adjusted probability to receive artificial nutrition varied from 12.1% in private for-profit clinics up to 19.9% in rehabilitation care facilities (p < 0.001).

Conclusions: Our study shows that in hospitalised patients with metastatic oesophageal or gastric cancer, the use of chemotherapy decreases while the use of artificial nutrition increases as death approaches. This raises important questions, as clinical guidelines clearly recommend to limit the use of artificial nutrition in contexts of limited life expectancy.

Place, publisher, year, edition, pages
2017. Vol. 79, 31-40 p.
Keyword [en]
End of life care, Nutrition therapy, Stomach neoplasm, Oesophageal neoplasm, (Medical/treatment) futility
National Category
Clinical Medicine Surgery
Identifiers
URN: urn:nbn:se:su:diva-144761DOI: 10.1016/j.ejca.2017.03.029ISI: 000402872000004PubMedID: 28458120OAI: oai:DiVA.org:su-144761DiVA: diva2:1127681
Available from: 2017-07-18 Created: 2017-07-18 Last updated: 2017-07-18Bibliographically approved

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