End-of-life care of patients with esophageal or gastric cancer: decision making and the goal of care

Figures & data

Table 1. Patient characteristics.

Characteristics	n	Percent
Number of all patients	160	100
Age at death
Under 70	83	51.9
70 or over	77	48.1
Gender
Female	63	39.4
Male	97	60.6
Diagnosis group
Esophageal cancer	78	48.8
Gastric cancer	82	51.2
Intention of cancer treatment
Curative treatment	69	43.1
Life-prolonging treatment	98	61.3
Palliative care	135	84.4
Anticancer treatments
Curative surgery	58	36.3
Chemotherapy	109	68.1
Adjuvant chemotherapy	56	35.0
Life-prolonging chemotherapy	82	51.2
1^st line	82	51.2
2^nd line	30	18.8
3^rd line	8	5.0
4^th line	4	2.5
Radiation therapy	61	38.1
Curative radiotherapy	28	17.5
Chemoradiotherapy	22	13.8
Palliative radiotherapy	33	20.6
For primary tumor	21	13.1
For metastatic lesion	12	7.5
Palliative and supportive care
DNR order	62	38.8
DNR made by oncologist	21	33.9
DNR made by other specialists	41	66.1
Palliative care unit visit	73	45.6
Nutrition therapist counselling	115	72.3
Weight loss ≥ 20 % of total bodyweight during the disease trajectory	72	45.0

DNR: do not resuscitate.

Table 2. Comparison of subgroups based on timing of the palliative care decision.

	All patients	No PC decision or PC decision ≤ 30 days before death	PC decision >30 days before death	p
n	160	73 (46%)	87 (54%)
Age in years at death, median (IQR)	69 (62–77)	68 (61.5–75)	70 (63–80)	0.045
Time in months from primary diagnosis of cancer to death, median (IQR)	11 (5–19)	9 (3–14.5)	13 (6–22)	0.003
Time in months from diagnosis of advanced cancer to death, median (IQR)	6 (3–12)	4 (1–9)	8 (5–14)	<0.001
Time in days from last life-prolonging chemotherapy to death, median (IQR)	69 (24–136.75)	22 (12.25–74.25)	90 (64–191.25)	<0.001
Time in months from last dose of radiation therapy to death, median (IQR)	4 (2–9.5)	2 (0.25–7.25)	5 (2–11.5)	0.671
Time in days from DNR order to death, median, (IQR)	25 (11–98)	15 (4.5–36.5)	48.5 (15–136.5)	0.015
Time in days from PC unit visit to death, median, (IQR)	67 (31–164.5)	15 (5–106)	70.5 (41.25–167.25)	0.177
Number of patients who visited PC Unit	73 (46%)	13 (18%)	60 (69%)	<0.001
Number of patients who visited ED during the last 30 days of life	61 (38%)	36 (49%)	25 (29%)	0.0009
Number of patients who were hospitalised during the last 30 days of life	63 (39%)	39 (53%)	24 (28%)	0.001
Place of death				0.001
Home/nursing home, n	28 (18%)	9 (12%)	19 (23%)
Tertiary/secondary hospital, n	27 (17%)	21 (29%)	6 (7%)
Specialized PC ward, n	40 (25%)	13 (18%)	27 (32%)
General primary care hospital ward, n	62 (40%)	30 (41%)	32 (38%)

PC: palliative care; IQR: interquartile range; ED: emergency department.

Figure 1. Symptoms for emergency department (ED) visits, reasons behind symptoms and reasons for hospitalizations. Upper GI constriction – no evidence of cancer progression, e.g., stricture. Chemotherapy side effects excluding chemotherapy-induced infection, infection including chemotherapy-induced infection.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.