End-of-life chemotherapy is associated with poor survival and aggressive care in patients with small cell lung cancer

• Published in: Journal of cancer research and clinical oncology 2018-08, Vol.144 (8), p.1591-1599
• Main Authors: Zhu, Yingming, Tang, Ke, Zhao, Fen, Zang, Yuanwei, Wang, Xiaodong, Li, Zhenxiang, Sun, Xindong, Yu, Jinming
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cancer Research; Chemotherapy; China - epidemiology; Cohort Studies; Electronic medical records; Female; Hematology; Humans; Internal Medicine; Lung cancer; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article – Clinical Oncology; Patients; Retrospective Studies; Small cell lung carcinoma; Small Cell Lung Carcinoma - drug therapy; Small Cell Lung Carcinoma - mortality; Terminal Care - methods; Terminal Care - statistics & numerical data; Tumors
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-018-2673-x

Background Concerns regarding end-of-life (EOL) chemotherapy are being increasingly raised. Tumor chemosensitivity may influence the decision for aggressive chemotherapy near the EOL. Data on EOL chemotherapy in highly chemosensitive tumors, such as small cell lung cancer (SCLC), are scarce. Method A total of 143 SCLC decedents were consecutively included. Data about clinical factors and treatment modalities were obtained from the electronic medical records. The relationships among EOL chemotherapy, clinical features, overall survival (OS), and aggressive care were investigated. Results About 64% of patients had chemosensitive disease. In total, 30.8 and 16.1% of patients received EOL chemotherapy within the last 1 and 2 months of life, respectively. Younger age was associated with a higher rate of EOL chemotherapy. We determined that EOL chemotherapy was related to inferior OS not only in the entire group, but also in the chemosensitive subgroup. Furthermore, more intensive care was observed among patients who underwent EOL chemotherapy compared with those who did not. Conclusions EOL chemotherapy was correlated with shorter survival and more aggressive care in patients with SCLC. More research is needed to develop indications for terminating palliative chemotherapy, to help physicians and patients with their difficult choices.