Highlights
- •Metastatic gastric and oesophageal cancers are associated with a poor prognosis.
- •Chemotherapy and artificial nutrition at the end of life are of questionable benefit.
- •Use of chemotherapy nutrition decreased as death approaches.
- •Use of artificial nutrition increases steadily in the final weeks of life.
Abstract
Aim
To evaluate the frequency and the factors associated with the use of chemotherapy
and artificial nutrition near the end of life in hospitalised patients with metastatic
oesophageal or gastric cancer.
Methods
Nationwide, register-based study, including all hospitalised adults (≥20 years) who
died with metastatic oesophageal or gastric cancer between 2010 and 2013, in France.
Chemotherapy and artificial nutrition during the final weeks of life were considered
as primary outcomes.
Results
A total of 4031 patients with oesophageal cancer and 10,423 patients with gastric
cancer were included. While the proportion of patients receiving chemotherapy decreased
from 35.9% during the 3rd month before death to 7.9% in the final week (p < 0.001
for trend), the use of artificial nutrition rose from 9.6% to 16.0% of patients. During
the last week before death, patients with stomach cancer were more likely to receive
chemotherapy (adjusted odds ratio (aOR) = 1.35, 95% CI = 1.17–1.56) but less likely
to receive artificial nutrition (aOR = 0.80, 95%CI = 0.73–0.88) than patients with
cancer of the oesophagus. The adjusted rates of chemotherapy use during the last week
of life varied from 1.6% in rural hospitals to 11.2% in comprehensive cancer centres,
while the adjusted probability to receive artificial nutrition varied from 12.1% in
private for-profit clinics up to 19.9% in rehabilitation care facilities (p < 0.001).
Conclusions
Our study shows that in hospitalised patients with metastatic oesophageal or gastric
cancer, the use of chemotherapy decreases while the use of artificial nutrition increases
as death approaches. This raises important questions, as clinical guidelines clearly
recommend to limit the use of artificial nutrition in contexts of limited life expectancy.
Keywords
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Article info
Publication history
Published online: April 27, 2017
Accepted:
March 26,
2017
Received in revised form:
March 16,
2017
Received:
November 15,
2016
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.
