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Observational Study
. 2023 Sep 6;22(1):131.
doi: 10.1186/s12904-023-01256-8.

Evaluation of factors predicting the benefit from systemic oncological treatment for severely ill hospitalized patients: a retrospective study

Milena Brachmans Mascarenhas Neves  1   2 , Yuri Costa Sarno Neves  3 , Juliana Vieira Biason Bomonetto  4 , Priscila Prais Carneiro Matos  4 , Auro Del Giglio  4 , Daniel de Iracema Gomes Cubero  4
Affiliations
Observational Study

Evaluation of factors predicting the benefit from systemic oncological treatment for severely ill hospitalized patients: a retrospective study

Milena Brachmans Mascarenhas Neves et al. BMC Palliat Care. .

Abstract

Background: Patients with cancer in the disease's end-stage with poor performance represent a challenging clinical scenario, as they have high chance of a fatal outcome due to clinical conditions, oncological emergencies, and/or metastatic disease. This study examines the factors predicting the potential benefit of "urgent" chemotherapy during hospitalization in this setting, thus addressing a research gap.

Methods: This retrospective observational study was conducted in the largest cancer center in the outskirts of São Paulo. It identified factors predicting the benefit from antineoplastic treatment in severe in-hospital patients admitted during 2019-2020, considering post-chemotherapy survival time as the main dependent variable. Data were retrieved from medical records. All patients aged ≥ 18 years, with an ECOG-PS score ≥ 2, and undergoing non-elective systemic cancer treatment were included.

Results: This study evaluated 204 records, of which 89 were included in the final analysis. A statistically significant association with the worse outcome (death within 30 days of chemotherapy) was found with higher ECOG performance status; chemotherapy dose reduction; lower values of serum albumin, hemoglobin, and creatinine clearance; and higher values of leukocytes, neutrophils, direct bilirubin, urea, and C-reactive protein. In the multivariate analysis, only albumin remained statistically associated with the outcome (hazard ratio = 0.35; confidence interval: 0.14, 0.90; p = 0.034).

Conclusions: Serum albumin and other clinical and laboratory variables might be associated with early post-treatment deaths in patients with cancer. The study data might help guide the decision to administer systemic treatment in this scenario and manage critically ill patients. This study adds to our knowledge of the factors predicting the objective benefits from "heroic" or "urgent" chemotherapy for hospitalized and severely ill patients with cancer.

Keywords: Chemotherapy; ECOG; End of life; Hospital medicine; Palliative care; Patients with cancer; Systemic oncological treatment.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart. ECOG = Eastern Cooperative Oncology Group Performance Status, N = number of patients
See this image and copyright information in PMC

References

    1. Cancer Statistics. 2018. https://www.inca.gov.br/numeros-de-cancer. Accessed 18 May 2021.
    1. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29(25):3457–65. doi: 10.1200/JCO.2011.34.7625. - DOI - PMC - PubMed
    1. Behl D, Jatoi A. What do oncologists say about chemotherapy at the very end of life? Results from a semiqualitative survey. J Palliat Med. 2010;13(7):831–5. doi: 10.1089/jpm.2009.0414. - DOI - PMC - PubMed
    1. Sánchez-Cuervo M, García-Basas L, Gómez de Salazar-López de Silanes P, Pueyo-López E, Bermejo-Vicedo CT. Chemotherapy near the end of life in onco-hematological adult patients. Am J Hosp Palliat Care. 2020;37(8):641–7. doi: 10.1177/1049909119901133. - DOI - PubMed
    1. Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC. The effect on survival of continuing chemotherapy to near death. BMC Palliat Care. 2011;10:14. doi: 10.1186/1472-684X-10-14. - DOI - PMC - PubMed

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