Dying in ICU more likely with palliative chemotherapy

From Medicine Today, April 2014:

Terminally-ill cancer patients receiving palliative chemotherapy in the four months before death are more likely to die in intensive care units, and more likely to have CPR and mechanical ventilation in the last week of life.

Analysis of data from a US-based prospective longitudinal study showed that 56% of 386 terminally-ill cancer patients received palliative chemotherapy in the months before their death, and this was associated with a 10-fold increase in the likelihood of CPR, ventilation or both.

Patients undergoing palliative chemotherapy were six times more likely to die in an ICU and had a greater likelihood of late referral to a hospice compared with patients who did not receive palliative chemotherapy.

The data, published online on 4 March in the BMJ, also revealed that patients undergoing palliative chemotherapy were less likely to acknowledge that their illness was terminal, to report having discussed end-of-life wishes with a physician, and to have completed a do-not-resuscitate order.

‘They were also more likely to express a preference to receive “life extending” care over comfort care (39% vs 26%, p=0.01), including chemotherapy if it might extend their life by one week (86% vs 60%, p<0.001), compared with those not receiving chemotherapy,’ researchers wrote. Read more.