End-of-life care of women with gynecologic malignancies; A pilot study

Nicole S. Nevadunsky, Lori Spoozak, Sharon Gordon, Enid Rivera, Kimala Harris, Gary L. Goldberg

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: There are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated. Methods: One hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Student t test and Mann-Whitney U test with SPSS software. Results: The mean age of patients was 60 years (range, 30Y94 years). Racial/ethnic distribution was as follows: 38%, white; 34%, black; and 15%, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30% received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0Y183 days). During the last 6 months of life, 19% were admitted to the intensive care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72%) versus 29 (41%), P = 0.004. Patients who were single were less likely to have a palliative medicine consultation, P = 0.005. Conclusions: End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality of life. These pilot data suggest that factors for implementation of timely hospice referral, family support, and legacy building should include specialists trained in palliative medicine.

Original languageEnglish (US)
Pages (from-to)546-552
Number of pages7
JournalInternational Journal of Gynecological Cancer
Volume23
Issue number3
DOIs
StatePublished - Mar 2013

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Terminal Care
Referral and Consultation
Neoplasms
Hospices
Medical Futility
Hospice Care
Drug Therapy
Electronic Health Records
Nonparametric Statistics
Hispanic Americans
Medical Records
Intensive Care Units
Software
Quality of Life
Demography
Databases
Students
Palliative Medicine

Keywords

  • Death and dying
  • Gynecologic malignancies
  • Hospice
  • Palliative medicine
  • Quality of life

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

End-of-life care of women with gynecologic malignancies; A pilot study. / Nevadunsky, Nicole S.; Spoozak, Lori; Gordon, Sharon; Rivera, Enid; Harris, Kimala; Goldberg, Gary L.

In: International Journal of Gynecological Cancer, Vol. 23, No. 3, 03.2013, p. 546-552.

Research output: Contribution to journalArticle

Nevadunsky, Nicole S. ; Spoozak, Lori ; Gordon, Sharon ; Rivera, Enid ; Harris, Kimala ; Goldberg, Gary L. / End-of-life care of women with gynecologic malignancies; A pilot study. In: International Journal of Gynecological Cancer. 2013 ; Vol. 23, No. 3. pp. 546-552.
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abstract = "Objective: There are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated. Methods: One hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Student t test and Mann-Whitney U test with SPSS software. Results: The mean age of patients was 60 years (range, 30Y94 years). Racial/ethnic distribution was as follows: 38{\%}, white; 34{\%}, black; and 15{\%}, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30{\%} received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0Y183 days). During the last 6 months of life, 19{\%} were admitted to the intensive care unit, 17{\%} were intubated, 5{\%} had terminal extubation, and 13{\%} had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50{\%} utilized hospice care, and 49{\%} had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72{\%}) versus 29 (41{\%}), P = 0.004. Patients who were single were less likely to have a palliative medicine consultation, P = 0.005. Conclusions: End-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality of life. These pilot data suggest that factors for implementation of timely hospice referral, family support, and legacy building should include specialists trained in palliative medicine.",
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