Association Between Antibiotic Withdrawal and End-of-Life Comfort in Patients with Advanced Cancer and Suspected...

The role of palliative care in addressing end-of-life needs and enhancing the comfort of patients with life-threatening illnesses is crucial. This study aimed to evaluate the relationship between antibiotic withdrawal and end-of-life discomfort in patients with terminal cancer with suspected infections.

A multicenter retrospective cohort study was conducted on patients aged ≥18 years with advanced cancer and life expectancy under six weeks, as determined by a Palliative Prognostic Index >4. Patients were admitted between January 2018 and December 2021, received antibiotics for suspected infections, and died during hospitalization. Patients were categorized into two cohorts based on whether antibiotic therapy was withdrawn or continued within 72-120 hours prior to death. Data were collected through medical chart review. End-of-life comfort was assessed using the validated Edmonton Comfort Assessment Form scale, with scores ≥4 indicating discomfort. Multivariate logistic regression was used to evaluate the association between antibiotic withdrawal and end-of-life discomfort.

A total of 187 patients were included, with a median age of 71 years; 81.8% had solid tumors, predominantly of gastrointestinal origin. Respiratory tract infections were the most common, and sepsis was present in 13% of cases. Symptoms remained mild in both groups, though pain was higher in the antibiotic withdrawal group (median score: 4 vs. 3). Multivariate analysis revealed no significant association between antibiotic withdrawal and end-of-life discomfort (odds ratio = 0.98; 95% confidence interval = 0.52-1.84).

Symptom management for pain, nausea, and dyspnea was generally effective, though moderate pain persisted in some patients after antibiotic withdrawal. Antibiotic withdrawal was not associated with increased discomfort at the end of life. These findings support aligning antibiotic decisions with comfort-focused goals in palliative care.