Systemic anticancer therapy near the end of life: an analysis of factors influencing treatment in advanced tumor disease.

end of life palliative care systemic anticancer treatment

Journal

ESMO open
ISSN: 2059-7029
Titre abrégé: ESMO Open
Pays: England
ID NLM: 101690685

Informations de publication

Date de publication:
29 Aug 2024
Historique:
received: 25 05 2024
revised: 17 07 2024
accepted: 26 07 2024
medline: 31 8 2024
pubmed: 31 8 2024
entrez: 30 8 2024
Statut: aheadofprint

Résumé

Systemic anticancer treatment (SACT) for advanced cancer patients with limited prognosis before death is associated with high toxicity and reduced quality of life. Guidelines discourage this approach as low-value care. However, a significant number of patients continue to receive SACT in the last 30 days of life. A retrospective study was carried out at the University Hospital Krems, encompassing the analysis of patients who were diagnosed with a solid tumor and died between 2017 and 2021, with a particular focus on the use of end-of-life (EOL) SACT. A total of 685 patients were included in the study. SACT was applied in 342 (49.9%) patients, of whom 143 (41.8%, total population: 20.9%) patients received SACT within the last 30 days of life. Median time from last SACT to death was 44.5 days. The analysis of potential factors impacting the administration of EOL SACT revealed the following significant findings: type of SACT [P < 0.001, targeted therapy odds ratio (OR) 5.09, 95% confidence interval (CI) 2.26-11.48; chemotherapy/targeted therapy OR 3.60, 95% CI 1.47-8.82; immune checkpoint inhibitor OR 2.32, 95% CI 1.37-3.92], no referral to palliative care (PC) (P = 0.009, OR 1.86, 95% CI 1.16-2.96), no admission to PC ward (P < 0.001, OR 2.70, 95% CI 1.67-4.35), and poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2, P < 0.001, OR 3.35, 95% CI 1.93-5.83). The timing of SACT near the EOL is significantly influenced by several factors, including the type of SACT, referral to PC services, admission to PC unit, and ECOG performance status. These findings underscore the complexity of treatment decisions in advanced cancer care and highlight the need for personalized, patient-centered approaches that consider both clinical and patient-related factors to optimize care at the EOL.

Sections du résumé

BACKGROUND BACKGROUND
Systemic anticancer treatment (SACT) for advanced cancer patients with limited prognosis before death is associated with high toxicity and reduced quality of life. Guidelines discourage this approach as low-value care. However, a significant number of patients continue to receive SACT in the last 30 days of life.
MATERIALS AND METHODS METHODS
A retrospective study was carried out at the University Hospital Krems, encompassing the analysis of patients who were diagnosed with a solid tumor and died between 2017 and 2021, with a particular focus on the use of end-of-life (EOL) SACT.
RESULTS RESULTS
A total of 685 patients were included in the study. SACT was applied in 342 (49.9%) patients, of whom 143 (41.8%, total population: 20.9%) patients received SACT within the last 30 days of life. Median time from last SACT to death was 44.5 days. The analysis of potential factors impacting the administration of EOL SACT revealed the following significant findings: type of SACT [P < 0.001, targeted therapy odds ratio (OR) 5.09, 95% confidence interval (CI) 2.26-11.48; chemotherapy/targeted therapy OR 3.60, 95% CI 1.47-8.82; immune checkpoint inhibitor OR 2.32, 95% CI 1.37-3.92], no referral to palliative care (PC) (P = 0.009, OR 1.86, 95% CI 1.16-2.96), no admission to PC ward (P < 0.001, OR 2.70, 95% CI 1.67-4.35), and poor Eastern Cooperative Oncology Group (ECOG) performance status (≥2, P < 0.001, OR 3.35, 95% CI 1.93-5.83).
CONCLUSION CONCLUSIONS
The timing of SACT near the EOL is significantly influenced by several factors, including the type of SACT, referral to PC services, admission to PC unit, and ECOG performance status. These findings underscore the complexity of treatment decisions in advanced cancer care and highlight the need for personalized, patient-centered approaches that consider both clinical and patient-related factors to optimize care at the EOL.

Identifiants

DOI: 10.1016/j.esmoop.2024.103683 PMID: 39214050
pubmed: 39214050
pii: S2059-7029(24)01452-2
doi: 10.1016/j.esmoop.2024.103683
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

103683

Informations de copyright

Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

N-S Le (NS)

Karl Landsteiner University of Health Sciences, Krems; Division of Palliative Care, Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.

A Zeybek (A)

Department of Internal Medicine, Kantonsspital Zug, Zug, Switzerland.

K Hackner (K)

Karl Landsteiner University of Health Sciences, Krems; Division of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems.

S Gottsauner-Wolf (S)

Strategy and Quality Medicine Medical Strategy and Development, Landesgesundheitsagentur Niederösterreich, St. Pölten, Austria.

I Groissenberger (I)

Karl Landsteiner University of Health Sciences, Krems.

F Jutz (F)

Karl Landsteiner University of Health Sciences, Krems.

L Tschurlovich (L)

Karl Landsteiner University of Health Sciences, Krems.

J Schediwy (J)

Karl Landsteiner University of Health Sciences, Krems.

J Singer (J)

Karl Landsteiner University of Health Sciences, Krems; Division of Palliative Care, Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria.

G Kreye (G)

Karl Landsteiner University of Health Sciences, Krems; Division of Palliative Care, Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria. Electronic address: gudrun.kreye@krems.lknoe.at.

Classifications MeSH