Palliative chemotherapy associated with more ICU treatment at end-of-life

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1. Palliative chemotherapy for terminally ill patients was associated to more intensive care in the last week of life compared to those who did not undergo palliative chemotherapy.

2. There was no significant difference in survival outcomes between populations

Evidence Rating Level: 2 (Good)

Study Rundown: This study investigated how palliative chemotherapy impacts end-of-life care, looking specifically at use of intensive medical care during the last week of life. This study was conducted across nine different cancer centers with n=386 participants enrolled between 2002 and 2008. Within the population, 56% of the cancer patients began receiving palliative chemotherapy after enrolling in the study (n=216) and 44% did not (n=170). Among the patients who engaged in palliative chemotherapy, 14% (n=30) underwent intensive medical care in the last week of life; compared to 2% (n=3) in the group that did not undergo palliative chemotherapy (p<0.001). Additionally, researchers found no significant difference in survival outcomes between the two groups. This study provides little detail regarding clinical patient circumstances and given the small sample size of the study, the authors were tentative with their argument that palliative chemotherapy does not necessarily extend life.

Click to read the study in BMJ

Chemotherapy use among Medicare beneficiaries at the end of life

In-Depth [prospective cohort study]: Researchers also analyzed the physical location of the patients’ death. Among those who received palliative chemotherapy during the study, 11% passed away in the intensive care unit; compared to 2% in the population that did not undergo palliative chemotherapy (p=0.02). As an additional note, researchers used a propensity score analysis to balance the various differences in patient populations. This was most apparent when looking at whether chemotherapy extended life by one week. Results showed that 89% of individuals who underwent palliative chemotherapy extended life by one week, compared to 62% among those who did not pursue palliative chemotherapy (p<.0.001). When the propensity analysis was applied, these percentages became 79.9% and 79.2% respectively, revealing no significant difference.

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