End-of-life care of patients with esophageal or gastric cancer: decision making and the goal of care

End-of-life care of patients with esophageal or gastric cancer: decision making and the goal of care

Overall survival (OS) with advanced esophageal or gastric cancer is poor. To avoid overly aggressive treatments at the end-of-life and assure adequate end-of-life quality, the decision to focus on symptom-centered palliative care (PC) and terminate anticancer treatments, i.e., the PC decision, shoul...

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Veröffentlicht in:Acta oncologica 2022-10, Vol.61 (10), p.1173-1178
Hauptverfasser: Kitti, Pauliina M., Anttonen, Anu M., Leskelä, Riikka-Leena, Saarto, Tiina
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decision making
end-of-life
esophageal cancer
Gastric cancer
goal of care
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container_end_page 1178
container_issue 10
container_start_page 1173
container_title Acta oncologica
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creator Kitti, Pauliina M.
Anttonen, Anu M.
Leskelä, Riikka-Leena
Saarto, Tiina
description Overall survival (OS) with advanced esophageal or gastric cancer is poor. To avoid overly aggressive treatments at the end-of-life and assure adequate end-of-life quality, the decision to focus on symptom-centered palliative care (PC) and terminate anticancer treatments, i.e., the PC decision, should be made in time. We reviewed the charts of patients (N = 160) with esophageal or gastric cancer treated at the Department of Oncology at Helsinki University Central Hospital in 2013 and deceased by December 2014. The use of acute services (Emergency department (ED) visits and hospitalizations) and places of death were compared according to the timing of the PC decision. Reasons for ED visits and hospitalizations were collected. The median OS from diagnosis of advanced cancer was 6 months. Anti-cancer treatments were never started for 34% of the patients. The PC decision was made early (>30 days before death) for 54% of the patients and late (≤30 days before death) or not at all for 46%. Patients with late or no PC decision died more often in tertiary/secondary hospital (29 versus 7%, p = 0.001) and had more ED visits (49 versus 29%, p 
doi_str_mv 10.1080/0284186X.2022.2114379
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Patients with late or no PC decision died more often in tertiary/secondary hospital (29 versus 7%, p = 0.001) and had more ED visits (49 versus 29%, p &lt; 0.001) and hospitalizations (53 versus 28%, p = 0.001) in their last month, and visited the PC unit less often (18 versus 69%, p &lt; 0.001), than the patients with early PC decision. The ED visits were most commonly related to cancer progression, and clinical deterioration (17%), fever (16%), and dysphagia (15%) were the most common symptoms. The decision to focus on PC and terminate anticancer treatments, i.e., the PC decision, was made late or not at all in every other patient, leading to increased tertiary/secondary hospital service use and deaths at tertiary/secondary hospital. 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source EZB-FREE-00999 freely available EZB journals; Taylor & Francis Journals Complete; Alma/SFX Local Collection
subjects decision making
end-of-life
esophageal cancer
Gastric cancer
goal of care
title End-of-life care of patients with esophageal or gastric cancer: decision making and the goal of care
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