Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care. Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. 30% of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62% more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1000 patient days (p < 0.001, OR 1.62 (1.23–2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18% (p = 0.045, OR 1.85 (1.01–3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1000 patient days in both groups by 29% (p = 0.02, IRR 0.71, CI 95% 0.53–0.96). Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.

中文翻译：

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死者住院的癌症患者的不良事件是生命终止癌症治疗中质量和安全性的衡量标准。

抗癌治疗使患者面临不良后果，例如毒性增加和生活质量下降，并且有明确的指南建议对生命周期临近的患者限制使用积极的抗癌治疗。这项研究的目的是调查生命最后30天给予的抗癌治疗与导致死亡的不良事件之间的关联，并阐明如何将不良事件用作生命周期癌症治疗中质量和安全性的衡量指标。回顾性队列研究于2012年和2013年在挪威的三家医院对247名死者住院的癌症患者进行了研究。采用全球触发工具方法来识别不良事件。我们使用Poisson回归和二元Logistic回归比较了生命的最后30天中发生的不良事件和抗癌治疗的相关性。死者住院的癌症患者中有30％在生命的最后30天接受了某种抗癌治疗，主要是全身性抗癌治疗。与最近30天未接受治疗的患者相比，这些患者发生的不良事件多62％，每1000患者每天发生39例不良事件与24例发生不良事件（p <0.001，或1.62（1.23-2.15））。与未接受此类治疗的患者相比，事件导致死亡的发生率分别为33％vs. 18％（p = 0.045，或1.85（1.01–3.36））。专家姑息治疗的接受使两组患者每1000天患者的AE发生率降低了29％（p = 0.02，IRR 0.71，CI 95％0.53-0.96）。在生命的最后30天给予抗癌治疗与不良事件发生率和相关死亡率显着增加有关。接受专家姑息治疗的患者不良事件显着减少，因此从患者安全角度考虑，建议尽早整合姑息治疗。