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Chemotherapy discontinuation processes in a gynecologic oncology population.

Publication ,  Journal Article
Watson, CH; Puechl, AM; Lim, S; Monuszko, K; Truong, T; Havrilesky, LJ; Davidson, BA
Published in: Gynecol Oncol
May 2021

OBJECTIVE: We sought to categorize the processes by which gynecologic oncology patients stop chemotherapy and to evaluate associations between these processes and end-of-life outcome metrics. METHODS: A cohort of patients with metastatic or recurrent gynecologic cancer in an outpatient setting from January 2016 to May 2018 was identified. All deceased patients in this cohort were included for analysis. Processes of discontinuing chemotherapy were categorized as: 1) definitive decision inpatient; 2) definitive decision outpatient; 3) delayed decision (eg: treatment break and never resumed chemotherapy); 4) no decision. Associations between patient characteristics and clinical outcomes of those who made a definitive outpatient decision versus those who made any other type of decision were assessed. RESULTS: 220 patients were identified; 205 patients were deceased at time of analysis. Of these, 36.6% made a definitive decision to stop chemotherapy as an outpatient, while 41.5% never made a decision to discontinue chemotherapy. Making a definitive decision as an outpatient, when compared to all other decision types, was associated with significantly lower incidence of death in the hospital (5.6% vs 21.1%, p < 0.004) and hospitalization within 30 days of death (20.8% vs 56.6%, p < 0.001), and significantly increased median time from last chemotherapy to death (135.5 vs 62 days, p < 0.001). CONCLUSION: Only one in three women in this cohort of patients deceased from gynecologic cancer made a definitive decision to discontinue chemotherapy in an outpatient setting, and this process was associated with improved end-of-life outcomes. Future efforts should examine the impact of interventions designed to increase the proportion of patients who transition away from chemotherapy via shared decision making in the outpatient setting.

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Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

May 2021

Volume

161

Issue

2

Start / End Page

508 / 511

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Outpatients
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Humans
  • Genital Neoplasms, Female
  • Female
  • Decision Making
  • Cohort Studies
 

Citation

APA
Chicago
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Watson, C. H., Puechl, A. M., Lim, S., Monuszko, K., Truong, T., Havrilesky, L. J., & Davidson, B. A. (2021). Chemotherapy discontinuation processes in a gynecologic oncology population. Gynecol Oncol, 161(2), 508–511. https://doi.org/10.1016/j.ygyno.2021.03.003
Watson, Catherine H., Allison M. Puechl, Stephanie Lim, Karen Monuszko, Tracy Truong, Laura J. Havrilesky, and Brittany A. Davidson. “Chemotherapy discontinuation processes in a gynecologic oncology population.Gynecol Oncol 161, no. 2 (May 2021): 508–11. https://doi.org/10.1016/j.ygyno.2021.03.003.
Watson CH, Puechl AM, Lim S, Monuszko K, Truong T, Havrilesky LJ, et al. Chemotherapy discontinuation processes in a gynecologic oncology population. Gynecol Oncol. 2021 May;161(2):508–11.
Watson, Catherine H., et al. “Chemotherapy discontinuation processes in a gynecologic oncology population.Gynecol Oncol, vol. 161, no. 2, May 2021, pp. 508–11. Pubmed, doi:10.1016/j.ygyno.2021.03.003.
Watson CH, Puechl AM, Lim S, Monuszko K, Truong T, Havrilesky LJ, Davidson BA. Chemotherapy discontinuation processes in a gynecologic oncology population. Gynecol Oncol. 2021 May;161(2):508–511.
Journal cover image

Published In

Gynecol Oncol

DOI

EISSN

1095-6859

Publication Date

May 2021

Volume

161

Issue

2

Start / End Page

508 / 511

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Outpatients
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Middle Aged
  • Humans
  • Genital Neoplasms, Female
  • Female
  • Decision Making
  • Cohort Studies