國家衛生研究院 NHRI:Item 3990099045/6137
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    題名: Use of chemotherapy at the end of life among Taiwanese cancer decedents, 2001-2006
    作者: Tang, ST;Liu, TW;Chang, WC;Wang, HM;Chen, JS;Koong, SL;Hsiao, SC
    貢獻者: National Institute of Cancer Research
    摘要: Background: The availability of new chemotherapeutic agents has lengthened the treatment timeline for advanced cancers and increases the likelihood of receiving chemotherapy near death. However, use of chemotherapy near the end of life may not benefit cancer patients, as evident by its precipitating emergency room visits, increasing intensive care unit care, precluding early hospice referral, highly frequent deaths in a hospital, elevated anxiety and depression, and a trend toward less satisfaction with care. Purpose of study: To assess the association between continuation of chemotherapy in the last month of life and patient demographics, disease characteristics, primary physician’s specialty, hospital characteristics, and healthcare resource availability at the hospital and regional levels. Methods: Retrospective population-based cohort study using administrative data among 204,850 Taiwanese cancer decedents in 2001–2006. Multivariate logistic regression was conducted to identify determinants of use of chemotherapy in the last month of life using the generalized estimating equation (GEE) method with robust standard errors accounting for correlation in the error term due to clustering of individuals in the same hospital. Results: Rates of continued chemotherapy in the last month of life for each study year were 17.5%, 17.4%, 17.3%, 19.0%, 20.0%, and 21.0%, respectively and have remained steady since 2001. Taiwanese cancer patients had greater propensity for continuation of chemotherapy in the last month of life if they were male (adjusted odds ratio [AOR]: 1.19, 95% confidence interval [CI]: 1.13–1.25), younger, single (1.21 [1.09–1.35]), had lower comorbidity levels, were diagnosed with hematologic malignancies (1.90 [1.09–1.35]) and breast cancer (1.24 [1.08–1.43]), had metastatic disease (1.36 [1.27–1.46]), and survived <1 year but longer than 2 months post-diagnosis. The propensity for continued chemotherapy in patients’ last month was significantly increased by being cared for by a medical oncologist (3.49 [3.04–3.99]) or in a teaching hospital (1.39 [1.11–1.74]) and with the highest intensity of total inpatient hospital beds (1.63 [0.99–2.68]) but was not influenced by regional healthcare resources (total hospital and hospice beds). Conclusion: The propensity to continue chemotherapy in the last month of life was determined by patient demographics and disease characteristics, physician specialty, and healthcare resources at the primary hospital level. Maintaining a delicate balance between deciding to continue chemotherapy and starting palliative care remains a challenge. However, appropriate discussion of transition from curative to palliative care may minimize the over-estimated effectiveness of chemotherapy to achieve end-of-life care that best meets cancer patients’ needs and preferences.
    日期: 2011-09
    關聯: European Journal of Cancer. 2011 Sep;47(Suppl 1):S229-S230.
    Link to: http://dx.doi.org/10.1016/S0959-8049(11)71098-X
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0959-8049&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000295752800792
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