Retrospective Analysis of Thoracic Oncology Practices: Attitudes and Beliefs about Aggressive Treatment at the End of Life

Research Article

Ann Hematol Oncol. 2019; 6(6): 1252.

Retrospective Analysis of Thoracic Oncology Practices: Attitudes and Beliefs about Aggressive Treatment at the End of Life

Faugeras E¹*, Guastella V², Merle P¹, Janicot H¹, Cabrespine A³, Jeannin G¹, Thibonnier L¹, Bay JO³ and Bailly S³

¹Department of the Thoracic Oncology, University of Clermont-Ferrand, France

²Department of Palliative Care Unit, University of Clermont-Ferrand, France

³Department of Hematology, University of Clermont- Ferrand, France

*Corresponding author: Faugeras E, Department of the Thoracic Oncology, University of Clermont-Ferrand, 58 rue Montalembert 63 000 Clermont-Ferrand, France

Received: March 19, 2019; Accepted: May 09, 2019;Published: May 16, 2019


Few studies exist on aggressive treatment at the end of life in thoracic oncology. The objective of this study was to assess practices in this area, and to establish predictive indicators of aggressive “end-of-life carerdquo;.

In this retrospective study, all patients who died over a 12-month period, who were treated for a cancer of the lung and pleura, in Pneumology Department of the French Hospital Gabriel Montpied in Clermont-Ferrand, were included. Three risk factors of aggressive end-of-life care were analyzed: anti-cancer treatments during the last month of the life, emergency hospitalization during the last month of the life and the death in hospital.

Among 189 patients, 93.6% have received at least one anti-cancer treatment. Patients receiving chemotherapy during the 4 and 2 last weeks of their life were 47.8% and 24.8% respectively. The Non-Small Cells Lungs Cancers (NSCLC) were most often treated during the last month of their life (OR=4.03 [1.41-11.54], p=0.0094). 11.6% patients were hospitalized in emergency departments during the last month of their life, the risk factor was a weight loss > 5% (OR=3.73 [1.23-11.31], p=0.02). The majority of patients (58.7%) were died during hospital stay.

Our results concur with those of the literature. In oncology, the end-of-life care is always a complex issue, which must consider different events in the end-of-life, relieve symptoms and not interfere with informed patient’s choice.

Keywords: Lung cancer; Aggressive treatment; End of life; Palliative care; Analysis of practices


Lung and pleural cancer is often diagnosed at a late stage: a patient out of 3 dies in 90 days having been taking care [1]. The last few years, the highlighting of biomolecular markers accessible to targeted therapies and immunotherapy came to change and transform the way of taking care of lung cancer and improve prognosis. Nonetheless, all patients can’t be granted to targeted therapy and immunotherapy [2-4].

There is no a standardized definition of aggressive treatment at the end of life in oncology [5-8]. According to several authors, it might be defined by death at hospital [9] and hospitalization in emergency or intensive care unit in 30 days before death. This definition is incomplete that’s why much often the aggressive treatment at the end of life is defined by the rate of patients who receive a specific treatment of cancer in the last four and two weeks of their life [10]. According to the American Society of Clinical Oncology (ASCO), one of the quality of life criteria is not being treated by specific oncologic treatment in the two last weeks of life.

In France, there are very few studies about aggressive treatments at the end of life, especially in thoracic oncology. That is why we did this survey.

The aim of the present work is to study within patient treated in the department of pneumology in the University Medical Center of Clermont-Ferrand, for lung cancer, the percentage of patients handled in an activate way in the last 4 and 2 weeks preceding the death and to establish the predictive factors of the aggressiveness of the care.

Materials and Methods

We included all the patients treated or followed within department of pneumology of Clermont-Ferrand for a lung cancer, histologically proven, died between January 1st, 2016 and December 31st, 2016. We collected the treatments received (number of lines, type and dates of treatments) and the date, place and cause of death.

Patients were considered in exclusive palliative care, which means a stop of the specific anti-cancer treatments, if the decision has been taken in a multidisciplinary meeting, in a medical mail of consultation, or in the report of hospitalization.

We considered criteria of aggressiveness of the care: the rate of patients receiving an anti-cancer treatment in the last 4 and 2 weeks preceding the death. We also took into account the parameters frequently associated to the aggressiveness of the care at the end of life: the rate of patients hospitalized in an emergency department, in an intensive care unit or resuscitation department in thirty days preceding the death and the rate of death at the hospital.

Quantitative variables were presented as median and standard deviation and qualitative variables as a percentage. Several comparisons were made in univariate analysis using the Chi2 test or Fisher’s exact test for qualitative analyzes; and the Student test or the Mann-Whitney test for quantitative analyzes.

Predictive factors were supplemented by multivariate analysis by introducing significant univariate variables (p <0.05) or by clinical relevance in a logistic regression model. This multivariate analysis was performed with a Cox model if overall survival was studied. The statistical software used was SEM [11].

Results and Discussion

189 patients with lung cancer or pleural mesothelioma were included in our study and their median age was 65. At initial diagnosis, there were 66% of patients with stage IV. Median time survival was 10 months. The characteristics of the population are indicated in the (Table 1).