Takaaki Tokito1, Haruyasu Murakami2, Keita Mori3, Iwao Osaka4, Toshiaki Takahashi2. 1. Division of Palliative Medicine, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka tokitou_takaaki@kurume-u.ac.jp. 2. Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun. 3. Clinical Trial Coordination Office, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Japan. 4. Division of Palliative Medicine, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun.
Abstract
OBJECTIVE: The American Society of Clinical Oncology published the goals of individualized care including advance care planning for advanced cancer patients in 2011. However, no data are available on the implementation status of advance care planning. METHODS: We retrospectively reviewed the electronic medical records and informed consent forms of consecutive Stage IV non-small cell lung cancer patients treated with chemotherapy between January 2010 and December 2012 at our institution. Two outcomes were defined to investigate the advance care planning implementation status: C-D, the duration from the last day of chemotherapy to death and D-D, that from the day of confirmed do-not-attempt-resuscitation order to death. RESULTS: The study included 136 eligible patients. The advance care planning implementation status in participating patients was as follows: 96 (70%) patients received information on 'incurable disease before first-line chemotherapy', 69 (50%) were informed about 'supportive care before first-line chemotherapy', whereas 43 (32%) learned about their prognosis. The do-not-attempt-resuscitation decision was reflected in 29 patients' will (21%). The median C-D was 64 days. Receipt of ≤2 chemotherapy regimens and provision of prognosis information to patients were significantly associated with long C-D in multivariate analysis. The median D-D was 25 days. Provision of information on supportive care before first-line chemotherapy and provision of prognosis information to patients were significantly associated with long D-D in multivariate analysis. CONCLUSIONS: Our results suggest that there is possible benefit from providing information on supportive care before first-line chemotherapy and informing patients about their prognosis in prolonging the duration of supportive care.
OBJECTIVE: The American Society of Clinical Oncology published the goals of individualized care including advance care planning for advanced cancerpatients in 2011. However, no data are available on the implementation status of advance care planning. METHODS: We retrospectively reviewed the electronic medical records and informed consent forms of consecutive Stage IV non-small cell lung cancerpatients treated with chemotherapy between January 2010 and December 2012 at our institution. Two outcomes were defined to investigate the advance care planning implementation status: C-D, the duration from the last day of chemotherapy to death and D-D, that from the day of confirmed do-not-attempt-resuscitation order to death. RESULTS: The study included 136 eligible patients. The advance care planning implementation status in participating patients was as follows: 96 (70%) patients received information on 'incurable disease before first-line chemotherapy', 69 (50%) were informed about 'supportive care before first-line chemotherapy', whereas 43 (32%) learned about their prognosis. The do-not-attempt-resuscitation decision was reflected in 29 patients' will (21%). The median C-D was 64 days. Receipt of ≤2 chemotherapy regimens and provision of prognosis information to patients were significantly associated with long C-D in multivariate analysis. The median D-D was 25 days. Provision of information on supportive care before first-line chemotherapy and provision of prognosis information to patients were significantly associated with long D-D in multivariate analysis. CONCLUSIONS: Our results suggest that there is possible benefit from providing information on supportive care before first-line chemotherapy and informing patients about their prognosis in prolonging the duration of supportive care.