[CHEMOTHERAPY FOR CANCER PATIENTS - ARE WE CHOOSING WISELY?]

The American Society of Clinical Oncology has identified non-evidence-based chemotherapy as one of the 10 most prevalent examples of futile care and has identified chemotherapy at the last month of life as a quality indicator of oncology practice.

To characterize chemotherapy treatment and the use of palliative and other healthcare services during the last year of life among cancer patients in an Israeli Health Maintenance Organization (HMO).

A cross-sectional study was conducted of members of Leumit Health Services (LHS) who died of cancer between 2009 and 2013. Data captured from LHS databases included: diagnosis, target drugs prescribed, health services utilization, and demographic data. Patients were stratified by time that elapsed between their last chemotherapy treatment and the date of death. The groups were compared in terms of demographics, morbidity, health services utilization and palliative care referrals over the six months prior to death.

The study included 2,617 patients who received chemotherapy during their last year of life. Of these patients, 18.8% received chemotherapy 0-14 days prior to death. Palliative care referrals were less frequent among patients who received their last chemotherapy treatment during the 14 days prior to death (15.8%) and highest among patients who received their last chemotherapy treatment ≥180 days prior to death (31.9%: P<0.0001(.

Survival and the probability of administering palliative care at the end of life are inversely associated with the probability of administering chemotherapy.

Efforts should be made to increase awareness amongst oncologists that aggressive treatment during the last weeks of life may be futile.