Chemotherapy use at the end of life: An analysis of the decision making process. F. Giorgi, R. Bascioni, M. Brugni, M. Safi, R. Berardi, L. Giustini, G. De Signoribus, R. Silva, S. Cascinu; Ospedale Madonna del Soccorso, San Benedetto d. TR., AP, Italy; Ospedale Murri, Fermo, Italy; Ospedale Profili, Fabriano, Italy; Oncologia Medica Università di Ancona, Ancona, Italy Abstract: Background: To evaluate the proportion of cancer patients (pts) receiving chemotherapy during the last 3 months of life and the factors influencing the decision to continue chemotherapy. Methods: We reviewed the clinical data of the pts followed in 4 oncology units and died in the year 2002. Results: Data of 292 pts were analyzed; the most frequent malignancies were NSCLC (57 pts), breast (33), colorectal (33), gastric (22). In the last 3 months of life 193 pts (66%) received chemotherapy, 98 (33%) in their last month of life; only 4 PR were documented and a clinical benefit was observed in 32 pts (10%). In the last month of life 12 out of 79 evaluable pts had grade 3-4 toxicities and there were 2 treatment-related deaths. The decision to continue chemotherapy in far advanced disease setting was suggested by the oncologist or by an external oncologist questioned for second opinion (2 cases). Twenty-three pts refused chemotherapy recommended by the oncologist and 8 pts requested chemotherapy instead of palliative care. There were differences among oncologists in the 4 oncology units: some were more palliative care oriented others were more aggressive, using chemotherapy until the last days of life. Data that supported the use of chemotherapy were scrutinized: in 30 cases there were good evidence-based informations (from phase 3 studies or meta-analysis), in 126 data ensued from phase 2 studies, in 3 from case reports, in 34 cases data were lacking. Conclusions: A high proportion of patients received chemotherapy in the last month of life without clinical benefit and significant side effects. The decision to continue chemotherapy was taken by the oncologist and was not always supported by reliable clinical studies. Rarely the patients requested chemotherapy contrasting with the oncologist’s opinion. Abstract No: 6081 Abstract # 6000 ASCO, 2004 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.