End-of-life medical treatments in the last two weeks of life in palliative care units in Japan, 2005-2006: A nationwide retrospective cohort survey

Background: Comprehensive information on end-of-life care in specialized palliative care settings is needed to assess the quality of care. Objective: This study aimed to investigate medical treatments in the last two weeks of life in a national sample of palliative care units in Japan. Design: Retrospective cohort study. Setting/Subjects: Medical charts of 2802 consecutive cancer patients who died in 37 palliative care units were reviewed. Measurements: Drug usage and treatments during the last two weeks of life were collected. A mixed-effect model was used to estimate the variations in care between institutions. Results: Opioid administration increased from 68% (two weeks before death) to 80% (last 48 hours); during the same period, nonsteroidal anti-inflammatory drugs and acetaminophen administration decreased from 59% to 45%, and corticosteroid administration decreased from 62% to 51%. As death neared, parenteral opioid administration increased (41%-74%). Morphine use increased (45%-70%), fentanyl use remained about the same (47%-40%), and oxycodone use decreased (18%-5%). Two thirds of patients received artificial hydration; doses >1000 mL/day (15%) and intravenous hyperalimentation (7%) were relatively rare during the last 48 hours. Variations in end-of-life medical treatments increased between palliative care units as death neared, especially anticholinergic, artificial hydration, oxygen inhalation, and palliative sedation use. Conclusions: These findings regarding the general course of palliative treatments for dying cancer patients are useful for clinical audits in general wards, by comparing end-of-life care. Variations in some end-of-life medical treatments between institutions increased as death neared, even in palliative care settings.