Patterns of Care in the Final Week of Life: A Comparative Analysis of Aggressive Treatment Versus Comfort-Centered Care Across Healthcare Settings.

Background and

Objectives

End-of-life care in oncology demands a holistic, multidisciplinary framework that pivots clinical priorities from disease-directed therapies toward symptom optimization, comfort, and patient dignity. Within this context, the present study investigated care delivery patterns among advanced cancer patients during their final week of life. Materials and

Methods

A retrospective medical record review was conducted, comparing an oncology ward, an intensive care unit, an inpatient palliative unit, and a home-based palliative care setting. We analyzed aggressive interventions, end-of-life care pathways, symptom management, medication use and rationalization, and transitions between care settings.

Results

Among the 306 patients studied, diagnostic testing and artificial hydration were universally administered in the oncology and intensive care unit (p < 0.001), where prescriptions focused primarily on pain management. Conversely, palliative care settings addressed a wider range of terminal symptoms. The rationalization of non-essential medications took place between 1.8 and 2.9 days before death, varying significantly across medication classes and clinical settings (p < 0.001). Additionally, intensive care unit admissions were more prevalent among patients with advanced cancer, while home-based patients underwent the greatest number of care transitions.

Conclusions

These findings highlight substantial differences in care across settings, emphasizing the need for coordinated planning, continuity, and patient-centered approaches to ensure comfort and dignity in the final week of life.