Palliative chemotherapy for breast cancer: A population-based cohort study of emergency hospital admissions and place of death
Menée en Angleterre à partir de données portant sur 10 966 patientes atteintes d'un cancer du sein diagnostiqué entre 1995 et 2017 et décédées entre 2014 et 2017, cette étude de cohorte analyse l'association entre l'utilisation d'une chimiothérapie palliative dans les 2 années précédant le décès, les hospitalisations non programmées et le lieu du décès
Objective : Patients with incurable breast cancer may be treated with chemotherapy to improve cancer-related symptoms, quality of life and survival. We examined the association between use of palliative chemotherapy towards the end of life in breast cancer patients and outcomes including unplanned hospital admission and place of death. Methods : A total of 10,966 women, treated with palliative chemotherapy for breast cancer (diagnosed 1995–2017 in England) within the 2 years prior to death (death between 2014 and 2017), were analysed. Logistic regression (outcome = emergency hospital admission in last 90 days of life yes/no; outcome = place of death hospital/other) was performed, adjusting for line of palliative chemotherapy in the last 90 days of life and patient demographics. Results : The odds of hospital admission reduced with increasing line of chemotherapy received (1st line odds ratio [OR] = 2.7, 2nd line OR = 2.1, 3rd line OR = 1.9, 4th+ line OR = 1.7; baseline chemotherapy) in last 90 days of life. A similar relationship was observed for hospital death (1st line OR = 2.4, 2nd line OR = 2.1, 3rd line OR = 1.7, 4th+ line OR = 1.5). Conclusion : This study finds palliative chemotherapy towards the end of life to be associated with increased odds of unplanned hospital admissions and hospital death. These findings can be used to inform discussions between patients and healthcare professionals towards the end of life.