Therapeutic aggressiveness in the oncological patient at the end of life: Experience in a tertiary hospital.

Background: The fundamental therapeutic objective in advanced or metastatic cancer is the control of symptoms without detriment to quality of life. Several studies show that cancer patients continue to receive cancer treatment until the last month of life, and this is related to poor-quality care. Methods: : This was a retrospective observational study conducted over a period of three years in a tertiary hospital. Data from deceased patients treated in the medical oncology unit for a solid tumour diagnosis were collected from January 1, 2016, to December 31, 2018. Demographic variables related to the tumour, treatment and death were also collected. For descriptive statistics, percentages with frequencies (categorical variables) and medians (continuous variables) were used. The nonparametric Kruskal–Wallis test was used for dichotomous variables, and the Mann–Whitney test with the Bonferroni correction was used for between-group comparisons of independent samples. The SPSS 20.0 program was used for statistical analysis. Results: : In total, 1611 patients were analysed; 40.16% and 17.94% of patients received treatment in the last 30 and 14 days of life, respectively. The median time from the last treatment to death was 39 days. By tumour location, breast cancer had the highest percentage of patients in active treatment in the last month of life (55.26%) and the lowest median from the last treatment to death (28 days). By age range, the group ≥ 75 years had the highest median (59 days) with a statistically significant difference compared to groups aged <75 years. A total of 76.22% of patients died in the hospital setting, of which 6.89% died in palliative care units. Conclusions: : The location of the primary tumour and age can influence decision-making in terminal cancer. The administration of cancer treatment in the final stages of life seems to have no benefit in terms of survival and can negatively influence the quality of life of patients. It is necessary to prioritize palliative care and early management by specialized units in the final phases of life.