BACKGROUND The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. METHODS A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to the cancer services meeting and a quality improvement intervention program was instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. RESULTS The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. CONCLUSION This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and a better risk benefit balance.

中文翻译：

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在生命的最后30天内进行抗癌治疗：来自澳大利亚地区癌症中心的审核和重新审核周期的结果。

背景技术医学肿瘤学中的治疗前景继续显着扩展。较新的疗法，尤其是免疫疗法，提供了深刻而持久的反应以及更可忍受的副作用的希望。对于患者和肿瘤学家而言，将这些信息整合到决策过程中具有挑战性。在生命的最后三十天内进行全身性抗癌治疗是护理质量的一项关键指标，并且是评估护理积极性的一个参数。方法回顾性分析2015年1月1日至2018年6月30日期间死亡的所有在Goulburn Valley Health肿瘤科接受治疗的患者的病历。在生命的最后30天内收集的与患者人口统计学，诊断，治疗和医院护理有关的信息。将这些结果提交给癌症服务会议，并制定了质量改善干预计划。为了衡量该干预措施的效果，对2018年7月1日至2018年12月31日死亡的所有患者的病历进行了第二次回顾性审查。结果初始审核期包括440名患者。在生命的最后30天内接受了120位患者（27％）的治疗。重新审核期包括75名患者。19例患者（25％）在生命的最后30天内接受了治疗。干预后化学疗法的治疗率降低了，而免疫疗法的治疗率却有所提高。一项单独的分析计算出化疗后30天内的死亡率，从接受化疗的患者总数开始，在重新审核期间最初为8％，最初为2％。在生命的最后30天内进行的治疗与积极治疗的更多使用相关，例如急诊科就诊，住院，重症监护病房（ICU）入院和临终关怀转诊。干预后，姑息治疗转诊率有所提高。结论该审核表明，质量改善干预措施可以在生命的最后30天内减少化疗的使用，从而影响护理指标的质量。但是，免疫疗法的使用有所增加，这可以通过增加获取机会和更好的风险收益平衡来解释。在生命的最后30天内进行的治疗与积极治疗的更多使用相关，例如急诊科就诊，住院，重症监护病房（ICU）入院和临终关怀转诊。干预后，姑息治疗转诊率有所提高。结论该审核表明，质量改善干预措施可以在生命的最后30天内减少化疗的使用，从而影响护理指标的质量。但是，免疫疗法的使用有所增加，这可以通过增加获取机会和更好的风险收益平衡来解释。在生命的最后30天内进行的治疗与积极治疗的更多使用相关，例如急诊科就诊，住院，重症监护病房（ICU）入院和临终关怀转诊。干预后，姑息治疗转诊率有所提高。结论该审核表明，质量改善干预措施可以在生命的最后30天内减少化疗的使用，从而影响护理指标的质量。但是，免疫疗法的使用有所增加，这可以通过增加获取机会和更好的风险收益平衡来解释。结论该审核表明，质量改进干预措施可以在生命的最后30天内减少化疗的使用，从而影响护理指标的质量。但是，免疫疗法的使用有所增加，这可以通过增加获取机会和更好的风险收益平衡来解释。结论该审核表明，质量改善干预措施可以在生命的最后30天内减少化疗的使用，从而影响护理指标的质量。但是，免疫疗法的使用有所增加，这可以通过增加获取机会和更好的风险收益平衡来解释。