(HealthDay News) — Terminally ill patients with cancer who receive chemotherapy at the end of life are at increased risk of dying in an intensive care unit (ICU) and receiving cardiopulmonary resuscitation (CPR) and/or mechanical ventilation, according to research published March 4 in BMJ.

Alexi A. Wright, MD, of Harvard Medical School in Boston, and colleagues conducted a secondary analysis of data from a prospective, longitudinal study of 386 patients with advanced cancer. The researchers examined the associations between palliative chemotherapy, end-of-life care, and place of death.

The researchers found that 56% of terminally ill cancer patients were receiving palliative chemotherapy at the time of enrollment.

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Patients receiving chemotherapy had higher rates of CPR, mechanical ventilation, or both, in the last week of life (14% vs 2%; adjusted risk difference, 10.5%; 95% confidence interval [CI], 5.0% to 15.5%) and late hospice referrals (54% vs 37%; adjusted risk difference, 13.6%; 95% CI, 3.6% to 23.6%), but no difference in survival (hazard ratio, 1.11; 95%, 0.90 to 1.38).

Patients who received palliative chemotherapy were more likely to die in an ICU (11% vs 2%; adjusted risk difference, 6.1%; 95% CI, 1.1% to 11.1%) and less likely to die at home (47% vs 66%; adjusted risk difference, −10.8%; 95% CI, −1.0% to −20.6%).

“Future work should explore how a decision to start chemotherapy, even many months before death, comes to be associated with how and where someone dies,” Michael W. Rabow, MD, of the University of California, San Francisco, Helen Diller Comprehensive Cancer Center, wrote in an accompanying editorial.


  1. Wright AA, Zhang B, Keating NL, et al. Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ. 2014; doi:10.1136/bmj.g1219.
  2. Rabow MW. Chemotherapy near the end of life. BMJ. 2014; doi:10.1136/bmj.g1529.