• Shirly Shapiro, Ofer Lavie, Meirav Schmidt, Eran Ben Arya, Jamal Dagash, Alexander Yosipovich, and Yakir Segev.
• Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel.
• Isr Med Assoc J. 2021 Sep 1; 23 (9): 556-562.

BackgroundEarly referral to palliative care services in patients with advanced cancer is widely accepted. In addition, the use of futile intervention at the end of life is a pivotal aspect of assessing quality of care at that time.ObjectivesTo evaluate the use of palliative care and aggressive treatments during the last month of life in women with gynecological malignancies.MethodsThe study was designed in two steps. The first step included a retrospective analysis of a gynecologic oncology cohort that underwent end-of-life (EOL) care. In the second part, a questionnaire regarding EOL care was completed by family members. Since our palliative care service became more active after 2014, we compared data from the years 2013-2014 to the years 2015-2019.ResultsWe identified 89 patients who died from gynecological malignancy during study period; 21% received chemotherapy and 40% underwent invasive procedures during their last month of life. A palliative care consultation was documented for 49% of patients more than one week before their death. No statistical difference was achieved between the two time periods regarding the use of chemotherapy or invasive procedures in the last month of life. Nonetheless, after the incorporation of palliative medicine more women had palliative care consultations and had EOL discussions. Most of the patients' relatives were satisfied with EOL care.ConclusionsMany aggressive interventions were given during the last month of life. EOL discussions were documented in the medical charts of most patients and the rates increased with time.

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