Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan

Abstract Background This study aimed to analyze the determinants of patients’ choice between palliative chemotherapy and best supportive care (BSC) and to investigate how this choice affects overall survival (OS) and length of hospitalization according to Eastern Cooperative Oncology Group (ECOG) pe...

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Main Authors: Yasuko Murakawa, Masato Sakayori, Kazunori Otsuka
Format: Article
Language:English
Published: BMC 2019-06-01
Series:BMC Palliative Care
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12904-019-0428-3
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spelling doaj-5c3bc26df47d4bd8aa0c60dd9a992e922020-11-25T03:28:59ZengBMCBMC Palliative Care1472-684X2019-06-011811810.1186/s12904-019-0428-3Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in JapanYasuko Murakawa0Masato Sakayori1Kazunori Otsuka2Department of Medical Oncology, Miyagi Cancer CenterDepartment of Medical Oncology, Miyagi Cancer CenterDepartment of Medical Oncology, Miyagi Cancer CenterAbstract Background This study aimed to analyze the determinants of patients’ choice between palliative chemotherapy and best supportive care (BSC) and to investigate how this choice affects overall survival (OS) and length of hospitalization according to Eastern Cooperative Oncology Group (ECOG) performance status (PS). Methods An oncologist explained the palliative chemotherapy and BSC options to 129 patients with incurable cancer during their first consultation. Data on the ECOG PS, treatment decision, OS, and the length of hospitalization were retrospectively collected over 4 years. Results Patients with an ECOG PS of 0–2 chose palliative chemotherapy more often than those with an ECOG PS of 3–4 (P < 0.01). Patients with ≤70 years chose palliative chemotherapy more often than those with > 70 (P < 0.05). And patients with gastric cancer and colon cancer chose palliative chemotherapy more often than those with CUP (carcinoma of unknown primary) (P < 0.05, P < 0.05 respectively). Factors associated with a significantly poorer OS in an adjusted analysis included the ECOG PS and treatment decision (hazard ratios: 0.18 and 0.43; P < 0.001, P < 0.01 respectively). In patients with an ECOG PS of 0–2, palliative chemotherapy was not associated with a longer OS compared with BSC (median OS: 14.5 vs. 6.8 months, respectively; P = 0.144). In patients with an ECOG PS of 3–4, palliative chemotherapy resulted in a significant survival gain compared to with BSC (median OS: 3.8 vs. 1.4 months, respectively; P < 0.05). Strong positive correlations between OS and the length of hospitalization were observed in patients with an ECOG PS of 3–4 who underwent palliative chemotherapy (r 2 = 0.683) and the length of hospitalization was approximately one-third of their OS. Conclusions The determinants for treatment choice were age, ECOG PS and type of cancer, not sex difference. Oncologists should explain to patients that OS and the length of hospitalization vary according to the ECOG PS when selecting between palliative chemotherapy and BSC.http://link.springer.com/article/10.1186/s12904-019-0428-3Best supportive careHospitalizationPalliative chemotherapyPerformance statusQuality of life
collection DOAJ
language English
format Article
sources DOAJ
author Yasuko Murakawa
Masato Sakayori
Kazunori Otsuka
spellingShingle Yasuko Murakawa
Masato Sakayori
Kazunori Otsuka
Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan
BMC Palliative Care
Best supportive care
Hospitalization
Palliative chemotherapy
Performance status
Quality of life
author_facet Yasuko Murakawa
Masato Sakayori
Kazunori Otsuka
author_sort Yasuko Murakawa
title Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan
title_short Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan
title_full Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan
title_fullStr Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan
title_full_unstemmed Impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable Cancer: a 4-year single institution experience in Japan
title_sort impact of palliative chemotherapy and best supportive care on overall survival and length of hospitalization in patients with incurable cancer: a 4-year single institution experience in japan
publisher BMC
series BMC Palliative Care
issn 1472-684X
publishDate 2019-06-01
description Abstract Background This study aimed to analyze the determinants of patients’ choice between palliative chemotherapy and best supportive care (BSC) and to investigate how this choice affects overall survival (OS) and length of hospitalization according to Eastern Cooperative Oncology Group (ECOG) performance status (PS). Methods An oncologist explained the palliative chemotherapy and BSC options to 129 patients with incurable cancer during their first consultation. Data on the ECOG PS, treatment decision, OS, and the length of hospitalization were retrospectively collected over 4 years. Results Patients with an ECOG PS of 0–2 chose palliative chemotherapy more often than those with an ECOG PS of 3–4 (P < 0.01). Patients with ≤70 years chose palliative chemotherapy more often than those with > 70 (P < 0.05). And patients with gastric cancer and colon cancer chose palliative chemotherapy more often than those with CUP (carcinoma of unknown primary) (P < 0.05, P < 0.05 respectively). Factors associated with a significantly poorer OS in an adjusted analysis included the ECOG PS and treatment decision (hazard ratios: 0.18 and 0.43; P < 0.001, P < 0.01 respectively). In patients with an ECOG PS of 0–2, palliative chemotherapy was not associated with a longer OS compared with BSC (median OS: 14.5 vs. 6.8 months, respectively; P = 0.144). In patients with an ECOG PS of 3–4, palliative chemotherapy resulted in a significant survival gain compared to with BSC (median OS: 3.8 vs. 1.4 months, respectively; P < 0.05). Strong positive correlations between OS and the length of hospitalization were observed in patients with an ECOG PS of 3–4 who underwent palliative chemotherapy (r 2 = 0.683) and the length of hospitalization was approximately one-third of their OS. Conclusions The determinants for treatment choice were age, ECOG PS and type of cancer, not sex difference. Oncologists should explain to patients that OS and the length of hospitalization vary according to the ECOG PS when selecting between palliative chemotherapy and BSC.
topic Best supportive care
Hospitalization
Palliative chemotherapy
Performance status
Quality of life
url http://link.springer.com/article/10.1186/s12904-019-0428-3
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