Annals of palliative medicine · 2025
Factors associated with aggressive care at the end of life for patients with gastrointestinal cancer.
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Kadono Toru, Yamaguchi Toshifumi, Kameishi Shin, Matsuo Nanako, Kodama Hiroyuki, Yukami Hiroki, Asaishi Ken, Nishikawa Hiroki
Аннотация
BACKGROUND: Although aggressive care at the end of life (ACEOL) for advanced gastrointestinal cancer can impose a significant burden on patients and healthcare systems, its prevalence and underlying determinants remain poorly understood. This study aimed to quantify the frequency of ACEOL and identify risk factors associated with such care in a Japanese population.
METHODS: We retrospectively reviewed 275 patients with advanced gastrointestinal cancer who initiated first-line palliative chemotherapy at Osaka Medical and Pharmaceutical University between 2017 and 2022. ACEOL was defined according to established indicators, including prolonged hospitalization, multiple emergency department visits or hospital admissions, initiation of a new chemotherapy regimen, intensive care unit admission, and death in an acute care hospital during the last month of life. Logistic regression analyses were performed to explore factors predictive of ACEOL.
RESULTS: Overall, 57.8% of patients (159/275) received at least one indicator of ACEOL. The most common factors were death in an acute hospital (38.5%) and prolonged hospitalization (>14 days; 33.8%). Patients receiving ACEOL had significantly shorter overall survival (OS) than those not receiving ACEOL (8.5 vs. 12.9 months, P=0.02). Younger age [odds ratio (OR) 2.01] and opioid use at the start of chemotherapy (OR 3.39) were identified as independent predictors.
CONCLUSIONS: More than half of these patients with advanced gastrointestinal cancer received ACEOL, partly driven by younger age and opioid use at baseline. These findings highlight the need for early identification of high-risk patients and proactive integration of palliative care services to decrease ACEOL.
METHODS: We retrospectively reviewed 275 patients with advanced gastrointestinal cancer who initiated first-line palliative chemotherapy at Osaka Medical and Pharmaceutical University between 2017 and 2022. ACEOL was defined according to established indicators, including prolonged hospitalization, multiple emergency department visits or hospital admissions, initiation of a new chemotherapy regimen, intensive care unit admission, and death in an acute care hospital during the last month of life. Logistic regression analyses were performed to explore factors predictive of ACEOL.
RESULTS: Overall, 57.8% of patients (159/275) received at least one indicator of ACEOL. The most common factors were death in an acute hospital (38.5%) and prolonged hospitalization (>14 days; 33.8%). Patients receiving ACEOL had significantly shorter overall survival (OS) than those not receiving ACEOL (8.5 vs. 12.9 months, P=0.02). Younger age [odds ratio (OR) 2.01] and opioid use at the start of chemotherapy (OR 3.39) were identified as independent predictors.
CONCLUSIONS: More than half of these patients with advanced gastrointestinal cancer received ACEOL, partly driven by younger age and opioid use at baseline. These findings highlight the need for early identification of high-risk patients and proactive integration of palliative care services to decrease ACEOL.