• Hiroaki Kajiyama, Fumi Utsumi, Makiko Higashi, Jun Sakata, Ryuichiro Sekiya, Mika Mizuno, Tomokazu Umezu, Shiro Suzuki, Eiko Yamamoto, Hiroko Mitsui, Kaoru Niimi, Kiyosumi Shibata, and Fumitaka Kikkawa.
• 1 Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine , Nagoya, Japan .
• J Palliat Med. 2014 Mar 1;17(3):325-30.

BackgroundIt remains unknown whether the end-of-life (EOL) environment influences survival after anticancer treatment, particularly for gynecologic malignancy.ObjectiveThe study's objective was to clarify whether the survival time varied depending on where patients spend the EOL.MethodsThis retrospective study included patients who received initial oncologic treatment but died due to cancer recurrence and/or progression. The subjects were a cohort of 181 gynecologic malignant tumor cases in a single institution from 2002 to 2008. Measurement was of postcancer treatment survival (PCS), defined as the time interval between the last date of anticancer treatment after recurrence/progression and death from the disease, analyzed on stratification by type of supportive care or where patients spent the EOL.ResultsThe median survival time was 26.1 (1.0-306.4) months. The distribution of the carcinoma type was as follows: 28.7% of patients with cervical (N=52), 27.6% with endometrial (N=50), and 43.1% with ovarian (N=79) cancer. The median PCS was 13.3 weeks. Patients in the hospice/home care group showed a significantly more favorable PCS than those in the hospital group (log rank: P=0.029). On multivariate analysis, the age (<60 versus ≥60) and site of supportive care (hospital versus hospice/home care) retained their significance as independent prognostic factors of poor PCS (age: HR=0.679, 95% CI, 0.496-0.928, P=0.0151; site of supportive care: HR=0.704, 95% CI, 0.511-0.970, P=0.0319).ConclusionsOur current data could be hypothesis generating; it is possible that the EOL environment is a crucial prognostic factor for survival after anticancer treatment.

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