Background: Immune checkpoint inhibitors have changed the landscape of cancer care by increasing progression-free and overall survival in some patients with cancer. We evaluated use and variables contributing to immune checkpoint inhibitor treatment near the end of life. Methods: We studied 157 patients who received immune checkpoint inhibitors and died between January 2015 and December 2018. All patients had a palliative care consult any time between starting an immune checkpoint inhibitor and death. Univariate and multivariate models were used to examine variables related to immune checkpoint inhibitor use near the end of life. Results: Among 157 patients studied, 42 (27%) received a dose of immune checkpoint inhibitor in the last 30 days of life. Those who received treatment in the last 30 days of life had lower hospice enrollment (19 [45%] vs 78 [69%], P = .007) and higher rates of dying in the hospital (23 [56%] vs 33 [29%], P = .002). The percentage of patients with Eastern Cooperative Oncology Group (ECOG) ≥3 at the time of last immune checkpoint inhibitor dose was higher in the group that received immune checkpoint inhibitor treatment in the last 30 days of life (11 [26%] vs 9 [8%], P = .003). Lack of traditional chemotherapy after immune checkpoint inhibitor, ECOG ≥3, and lack of hospice enrollment were independently associated with receiving immune checkpoint inhibitor in the last 30 days of life. Conclusion: Immune checkpoint inhibitor use in the last 30 days of life is common and associated with poor performance status, lower hospice enrollment, and dying in the hospital.
S17 30 patients enrolled, with 25 patients finished more than 6 cycles. The median age and mean BSA was 58.5(19.0, 77.0) and 1.61±0.14, with 60% were female. After cycles 8th, 80% preferred R-SC over R-IV (95%CI; 59.3-93.2). Major reason for preference R-SC was less time in clinic (34%), feel more comfortable (33%), less emotional distress (20%). The mean score of five RASQ domain following R-SC and R-IV were 80.94±16.48 and 74.06±15.61. 92.3% of R-SC and 65.4% of R-IV feels timing were just right. The mean score of three CTSQ domain following R-SC and R-IV were 74.22±21.94 and 74.62±16.64. The ORR was similar for R-SC and R-IV with 93%. The average infusion time per cycle for R-SC and R-IV were 6.32±1.62 and 212.44±53 minutes and productivity lost were 8.66±2.22 and 291.28±73.26 THB respectively. Safety were similar in both group. CONCLUSIONS: In Thai context, R-SC demonstrated a strong preference from patients' perspective, saving resource utilization and economic burden, whereas both formulations demonstrated similar efficacy and safety.
Conducting a FM is an advanced skill. This study shows that it is possible to train fourth year students to lead FMs and identify their strengths, needs using a FM OSCE.
11533 Background: Studies of chemotherapy near the end of life reveal increased costs, adverse effects and minimal clinical benefit. Immune Checkpoint Inhibitor (ICI) use near the end of life has not been described. We studied factors related to ICI use near the end of life. Methods: We conducted a single-institution retrospective chart review of patients who received ICI and died between August 2014 and December 2018. End of life ICI (EOL-ICI) was defined as treatment within the last 30 days of life and comparisons were made to patients who received treatment > 30 days from end of life (non EOL-ICI). Results: 441 patients were reviewed. Mean age was 64 and 182 (41%) were female. 294 (67%) received ICI within the last 90 days of life and 117 (27%) within the last 30 days of life. At time of last ICI, 145 (33%) had brain metastases and 416 (94%) were stage 4. The most common cancers were melanoma (124, 28%), NSCLC (118, 27%) and urothelial carcinoma (34, 8%). The EOL-ICI group had a higher proportion of patients with ECOG ≥3 at time of last treatment (22% vs. 7%, p = < .001), higher rate of death in hospital (32% vs. 18%, p = 0.003) and lower hospice enrollment (52% vs. 76%, p = < .001). The EOL-ICI group received fewer ICI doses (mean 5.1 vs 6.7, p = 0.016). A higher proportion of patients in the EOL-ICI group were just beginning treatment and received ≤ 3 doses (60% vs 40%, p < .001). There was no difference in mean age or presence of brain metastases between the groups. Even when the cutoff for EOL-ICI is extended from 30 to 90 days, there remain significant differences in ECOG, hospice enrollment and starting ICI but no difference in rate of dying in the hospital. Conclusions: One out of four patients studied received ICI within the last 30 days of life. EOL-ICI treatment is associated with higher rates of death in the hospital and lower hospice enrollment. Our results suggest that performance status is important when considering treatment with ICI. Use of ICI in the last 30 days of life had minimal clinical benefit and high cost.
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