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Vol.49 No.6 contents | Japanese/English |
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- Original Article -
Terminating Chemotherapy and Transition to Palliative Care for Patients with Recurrent Non-small Cell Lung Cancer in the Terminal Stage
Kikuo Nakano1, Takeshi Masuda1, Takashi Yoshida1, Kazuhide Fukuhara11Department of Respiratory Medicine, National Hospital Organization Kure Medical Center, Japan
Objective. To clarify issues when terminating chemotherapy and shifting to palliative care for patients with recurrent non-small cell lung cancer (NSCLC) in the terminal stage. Methods. We conducted a retrospective review of patients who had had the first line of chemotherapy from January, 2002 to September, 2007, continued to have had the second or more lines of chemotherapy regimens, and had died by April, 2008. We carefully examined the patients' backgrounds, administration schedule of chemotherapy and the response to it, and the timing of having terminated chemotherapy and having been referred to palliative or hospice care. Results. Patients were 49 men and 12 women with a median age of 64 years old. A total of 25 patients (41%) had chemotherapy within 30 days of their death. Patients received platinum-based therapy in the first-line (66%), and gefitinib therapy in all lines. The response rate decreased in each subsequent line of chemotherapy, and the response rate and the median overall survival period because of the last treatment (between the second and sixth lines) were 10% and 3 months respectively. The poor performance status (56%), and complications and/or toxicity (32%) were the causes for termination of chemotherapy in the last month of life. Comparing patients who had chemotherapy within 30 days of their death and those who did not, the former had a shorter period from referral to a palliative care department to death (an average of 22.4 days versus 61.9 days), and they had significantly lower proportion of death in hospices (P=0.0373). Conclusion. Shifting to palliative or hospice care is delayed when chemotherapy is given to patients with non-small cell lung cancer just before death, because it has strong toxicity and minimum efficacy.
key words: Terminal care, Chemotherapy, Palliative care, Non-small cell lung cancer
Received: January 9, 2009
Accepted: April 27, 2009
JJLC 49 (6): 836-843, 2009
