Use of chemotherapy at the end of life in a Portuguese oncology center

Chemotherapy plays a major role in the treatment of cancer. However, it is sometimes thought of as being taken too far, being used in many cases close to death. The purpose of this study is to determine the proximity of chemotherapy use to the patient’s death in our hospital.

This study comprised the analysis of the charts of 1,064 patients aged over 16 years with solid tumors who died in 2002 and were treated at the Porto Section of the Portuguese Institute of Oncology.

Four hundred ten of the 1,064 patients (39%) underwent chemotherapy. Fifty-two percent of those that underwent chemotherapy did so in the last 6 months of their lives, 31% in the last 3 months, 13% in the last month, and 3% in the last week. In the context of the total cohort of 1,064, the percentages of those that underwent chemotherapy was 20, 12, 5, and 1%, respectively. By multivariate analysis, age <65 years, breast and lung cancers, and metastases were positively associated with chemotherapy; kidney cancer and comorbidity were associated with a lower probability of undergoing chemotherapy. Three hundred sixty-one patients (34%) were admitted to the palliative care unit of the hospital.

It was concluded that in this hospital, chemotherapy is not used as close to death as often as most professionals feel and the literature reports. There are various possible explanations for this discrepancy; one of them may be the influence of health care systems. It would be useful to see what is happening in other countries with different health care systems.