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Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study

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Department of Medical Oncology, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, 1081 HV Amsterdam, The Netherlands
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Zorgverzekeraars Nederland, 3708 JE Zeist, The Netherlands
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Vektis, 3708 JE Zeist, The Netherlands
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CZ Zorgverzekeringen, 5038 KE Tilburg, The Netherlands
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Zilveren Kruis, 3833 LB Leusden, The Netherlands
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Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, 1081 HV Amsterdam, The Netherlands
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Elisabeth-TweeSteden Hospital, 5042 AD Tilburg, The Netherlands
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Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
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Department of Research & Development, Netherlands Comprehensive Cancer Organisation, 3511 DT Utrecht, The Netherlands
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Current Address: Department of Oncology, Amsterdam UMC/University of Amsterdam De Boelelaan 1117, Room ZH 3A46, 1081 HV Amsterdam, The Netherlands.
Cancers 2021, 13(1), 145; https://doi.org/10.3390/cancers13010145
Received: 18 November 2020 / Revised: 23 December 2020 / Accepted: 23 December 2020 / Published: 5 January 2021
This is the first nationwide study on chemotherapy use and intensive care unit (ICU) admission in the last three months before death in patients with cancer of the stomach or esophagus. Chemotherapy use and ICU admission shortly before death were relatively infrequent in the Netherlands. Chemotherapy was used less often in hospitals that treat many patients compared to hospitals that treat fewer patients. In patients that received chemotherapy before their final three months before death, chemotherapy was prescribed four times more often in the last three months before death compared to patients without previous chemotherapy use.
Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroesophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy. View Full-Text
Keywords: gastroesophageal cancer; palliative care; nationwide; end of life gastroesophageal cancer; palliative care; nationwide; end of life
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MDPI and ACS Style

Besseling, J.; Reitsma, J.; Van Erkelens, J.A.; Schepens, M.H.J.; Siroen, M.P.C.; Ziedses des Plantes, C.M.P.; van Berge Henegouwen, M.I.; Beerepoot, L.V.; Van Voorthuizen, T.; Van Zuylen, L.; Verhoeven, R.H.A.; van Laarhoven, H. Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study. Cancers 2021, 13, 145. https://doi.org/10.3390/cancers13010145

AMA Style

Besseling J, Reitsma J, Van Erkelens JA, Schepens MHJ, Siroen MPC, Ziedses des Plantes CMP, van Berge Henegouwen MI, Beerepoot LV, Van Voorthuizen T, Van Zuylen L, Verhoeven RHA, van Laarhoven H. Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study. Cancers. 2021; 13(1):145. https://doi.org/10.3390/cancers13010145

Chicago/Turabian Style

Besseling, Joost; Reitsma, Jan; Van Erkelens, Judith A.; Schepens, Maike H.J.; Siroen, Michiel P.C.; Ziedses des Plantes, Cathelijne M.P.; van Berge Henegouwen, Mark I.; Beerepoot, Laurens V.; Van Voorthuizen, Theo; Van Zuylen, Lia; Verhoeven, Rob H.A.; van Laarhoven, Hanneke. 2021. "Use of Palliative Chemotherapy and ICU Admissions in Gastric and Esophageal Cancer Patients in the Last Phase of Life: A Nationwide Observational Study" Cancers 13, no. 1: 145. https://doi.org/10.3390/cancers13010145

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