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Intensity of Cancer Care Near the End-of-Life at a Tertiary Care Cancer Center in Jordan.

PURPOSE: Chemotherapy use in the last month of life is an indicator of poor quality of end-of-life care. We assessed the frequency of chemotherapy use at the end-of-life at our comprehensive cancer center in Jordan, and identified the factors associated with chemotherapy use.

PATIENTS AND METHODS: We conducted a retrospective chart review to examine the use of chemotherapy in the last 30 days and 14 days of life in consecutive adult cancer patients seen at King Hussein Cancer Center (KHCC) who died between January 1, 2010 and December 31, 2012. We collected data on patient and disease characteristics, palliative care referral, and end-of-life care outcome indicators.

RESULTS: Among the 1714 decedents, 310 (18.1%) had chemotherapy use in the last 30 days and 142 (8.3%) in the last 14 days of life. Over half (910; 53.1%) had a palliative care referral. Chemotherapy use in the last 30 and 14 days of life were associated with younger age (odds ratio [OR] 0.99/yr, P=0.01; and OR 0.99/yr, P=0.01, respectively) and hematological malignances (OR 1.98, P<0.001; and OR 2.85, P<0.001, respectively). Palliative care referral was significantly associated with decreased use of chemotherapy in the last 30 (OR 0.30, P<0.001) and 14 (OR 0.15, P<0.001) days of life.

CONCLUSIONS: A sizable minority of cancer patients at KHCC received chemotherapy at the end-of-life. Younger patients and those with hematological malignancies were more likely to receive chemotherapy while those referred to palliative care were significantly less likely to receive chemotherapy at the end-of-life.

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