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When to stop futile treatment towards end of life in gynaecological cancer patients: a population-based study in oslo county, norway
  1. K Lindemann1,2,
  2. H Liland1,
  3. B Kloppen1,
  4. M Sylten Engh1,
  5. M Turzer3 and
  6. T Paulsen1
  1. 1Department of Gynaecological Cancer, Oslo University Hospital
  2. 2University of Oslo, Oslo
  3. 3Department of Oncology, Hospital Østfold Kalnes, Kalnes, Norway


Introduction/Background End of life (EOL) care for patients with gynaecologic malignancies often includes futile chemotherapy and invasive procedures. At the same time symptom burden is high and integration of palliative care is crucial. We aimed to assess care in the last weeks of life in gynaecological cancer patients.

Methodology This retrospective study included all gynecological cancer patients who died between Jan 1st 2015 and Dec 31st, 2017 in Oslo County, Norway. The modified Glasgow Prognostic score (mGPS) was calculated at start of last line of chemotherapy. Descriptive statistics were used. Survival was estimated with the Kaplan-Meier method. P-values of <0.05 were considered statistically significant.

Results We included 215 patients, of those 53% with ovarian-, 30% with endometrial-, 14% with cervical cancer and 3% with other gynecological cancers. 15% had >3 lines of treatment prior to death. 163 patients died of their cancer and were analyzed for EOL care. In the last 30 days of life, 15% of the patients received chemotherapy, 67% were admitted to hospital and 35% had a surgical intervention (i.e. drainage of pleural effusions/ascites, surgery for bowel obstruction). In 62% a palliative care team was involved, in half of them in the last 30 days only. There was less use of chemotherapy towards EOL when a palliative care team was involved earlier (within 60 days before death) (6.8% vs 21.3%, p<0.019). Patients with a mGPS of 2 had significantly shorter survival from start of last chemotherapy compared to patients with a score ≤1 (median 2.5 vs 6.3 months, p<001).

Conclusion Too few patients received multidisciplinary care including palliative care towards EOL. Gynaecological cancer patients may benefit from early integration of palliative care to avoid futile treatment towards EOL. The modified GPS seems to be a helpful tool when deciding on palliative chemotherapy.

Disclosure Nothing to disclose.

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