Aggressive anticancer treatment in the last 2 weeks of life.

BACKGROUND: There is a concern that terminally ill cancer patients may be aggressively treated due to the rapidly growing possibilities of anticancer treatment. The aim of this study was to evaluate the use of anticancer treatment at the end of life (EoL). MATERIALS AND METHODS: This retrospective study included adult patients with advanced solid cancers who were treated at the Institute of Oncology Ljubljana and died of cancer between January 2015 and December 2019. A multiple logistic regression model was used to assess an association between the aggressiveness of anticancer treatment (i.e. systemic therapy, radiotherapy and surgery) in the last 2 weeks of life and year of death, age at death, sex, prognosis of cancer and enrolment into the specialist palliative care (SPC). RESULTS: We included 1736 patients in our analysis. Overall, 13.7% of patients were enrolled into the SPC and 14.4% received anticancer treatment in the last 2 weeks of life. The odds of receiving anticancer treatment significantly increased over time [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.04-1.27]. There was an increased use of novel systemic therapy (e.g. small-molecule targeted therapy and immunotherapy) at the EoL. Older patients had significantly lower odds to receive anticancer treatment in the last 2 weeks of life as compared to younger patients (OR 0.96, 95% CI 0.95-0.98). As compared to patients receiving only a standard oncology care, those also enrolled into the SPC had significantly lower odds for anticancer treatment in the last 2 weeks of life (OR 0.22, 95% CI 0.12-0.43). CONCLUSIONS: Terminally ill cancer patients have increased odds for receiving anticancer treatment, especially novel systemic therapies, in the last 2 weeks of life. Younger patients and those not enrolled into the SPC are at particular risk for anticancer treatment at the EoL.

Carbon monoxide poisoning in wood pellet storerooms.

Background: Carbon monoxide is the leading cause of mortality from unintentional poisoning in Slovenia. It has been shown that carbon monoxide levels can rise in wood pellet storerooms because of chemical degradation of pellets, even at room temperature. We present a case of lethal carbon monoxide poisoning with first responder carbon monoxide exposure. Aims: To highlight the dangers rescuers face during interventions in pellet storerooms and the need for preventive precautions. Case report: Paramedics and firemen were called to help an unconscious man in a wood pellet storeroom. Firemen immediately evacuated the victim and paramedics began cardiopulmonary resuscitation. Soon after, rescuers complained of dizziness and developed headache, nausea and fatigue. A carbon monoxide level of 600 ppm was detected. Three rescuers were treated with 100% oxygen. Blood carboxyhaemoglobin levels were up to 8% on arrival at the emergency department. The victim died and autopsy confirmed carbon monoxide poisoning. Conclusions: First responders have to be aware of the dangers of carbon monoxide in wood pellet storerooms. Basic precautions and safety instructions should be followed before entering a wood pellet storeroom. Carbon monoxide should be measured before entering and self-contained breathing apparatus should be used. Wood pellet storerooms require continuous ventilation and should be equipped with carbon monoxide detectors.