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Aggressiveness of cancer treatment in patients hospitalized in a supportive care unit

Luthy, C. ; Pugliesi, A. ; Rapiti, E. ; Kossovsky, M. ; Dietrich, P. ; Cedraschi, C. ; Allaz, A.

In: Supportive Care in Cancer, 2015, vol. 23, no. 2, p. 325-331

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    Title
    • Aggressiveness of cancer treatment in patients hospitalized in a supportive care unit
    Author
    • Luthy, C.. Department of Rehabilitation and Geriatrics, Division of General Medical Rehabilitation (SMIR-BS), Geneva University Hospitals, University of Geneva, 26, avenue Beau-Séjour, 1211, Geneva 14, Switzerland
    • Pugliesi, A.. Department of Internal Medicine, Division of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
    • Rapiti, E.. Geneva Cancer Registry, Institute of Social and Preventive Medicine, Geneva University, Geneva, Switzerland
    • Kossovsky, M.. Department of Rehabilitation and Geriatrics, Division of General Medical Rehabilitation (SMIR-BS), Geneva University Hospitals, University of Geneva, 26, avenue Beau-Séjour, 1211, Geneva 14, Switzerland
    • Dietrich, P.. Department of Internal Medicine, Division of Oncology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
    • Cedraschi, C.. Department of Rehabilitation and Geriatrics, Division of General Medical Rehabilitation (SMIR-BS), Geneva University Hospitals, University of Geneva, 26, avenue Beau-Séjour, 1211, Geneva 14, Switzerland
    • Allaz, A.. Department of Rehabilitation and Geriatrics, Division of General Medical Rehabilitation (SMIR-BS), Geneva University Hospitals, University of Geneva, 26, avenue Beau-Séjour, 1211, Geneva 14, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:330986
    Summary
    Purpose: This study aimed at determining the aggressiveness of chemotherapy (CT)in patients hospitalized in a supportive care unit (focusing on mortality, patient profiles, survival, readmissions, and CT near death). Methods: In a prospective cohort study, 247 consecutive patients were investigated at the admission (disease, treatments, oncologist's theoretical survival prognosis, internist's clinical global impression (CGI)). A 3-and 6-month follow-upwas performed. Survival was assessed up to 3years. Results: Various cancer diagnoses were represented in polymorbid patients. Since disease onset, 69.6% had received a first line of CT only; 147 patients (59.5%) had CT at the admission; median CGI was 3 (range = 0-10); and theoretical survival prognosis was <12months in 65.2%. In-hospitalmortality rate was 21%. Odds of receiving CT was inversely associated with age (OR for patients ≥71years vs. patients <50years 0.19; 95% CI 0.06-0.65; p = 0.02) and number of previous CT lines (OR for patients with 2-4 lines vs. those with 1 line 0.14; 95% CI 0.06-0.34; p = 0.000). In the multiadjusted model, 6-monthsurvival remained associated with CT at the admission (HR 1.86; 95% CI 1.31-2.65; p = 0.001), CGI (per point HR 0.84; 95% CI 0.73-0.96; p = 0.013), and theoretical survival prognosis (per category HR 0.53; 95% CI 0.44-0.66; p = 0.000). Very few patients needed readmission related to CT's adverse effects. From admission and throughout follow-up, 24 patients (9.7%) had received CT during their last 14days of life. Conclusion: This study showed that a supportive care program can benefit a heterogeneous population as it contributes to assess clinical risks and benefits of CT and prevent aggressive care near death.