Anti-tumor treatment and healthcare consumption near death in the era of novel treatment options for patients with melanoma brain metastases

Abstract

Background Effective systemic treatments have revolutionized the management of patients with metastatic melanoma, including those with brain metastases. The extent to which these treatments influence disease trajectories close to death is unknown. Therefore, this study aimed to gain insight into provided treatments and healthcare consumption during the last 3 months of life in patients with melanoma brain metastases. Methods Retrospective, single-center study, including consecutive patients with melanoma brain metastases diagnosed between June-2015 and June-2018, referred to the medical oncologist, and died before November-2019. Patient and tumor characteristics, anti-tumor treatments, healthcare consumption, presence of neurological symptoms, and do-not-resuscitate status were extracted from medical charts. Results 100 patients were included. A BRAF-mutation was present in 66 patients. Systemic anti-tumor therapy was given to 72% of patients during the last 3 months of life, 34% in the last month, and 6% in the last week. Patients with a BRAF-mutation more frequently received systemic treatment during the last 3 (85% vs. 47%) and last month (42% vs. 18%) of life than patients without a BRAF-mutation. Furthermore, patients receiving systemic treatment were more likely to visit the emergency room (ER, 75% vs. 36%) and be hospitalized (75% vs. 36%) than those who did not. Conclusion The majority of patients with melanoma brain metastases received anti-tumor treatment during the last 3 months of life. ER visits and hospitalizations occurred more often in patients on anti-tumor treatment. Further research is warranted to examine the impact of anti-tumor treatments close to death on symptom burden and care satisfaction.

Systemic therapy timing and use in patients with advanced melanoma at the end of life: A retrospective cohort study

“…This is probably because the side effects of targeted therapy are in general less severe compared to the side effects of immune therapy. Also, targeted therapy induces faster response and therefore also serves a palliative purpose in terms of quality of life preservation 12,13 …”

“…12 We found that only 28 out of 89 patients started with a first (new) line of targeted therapy within 30 days prior to death, which is less than a previous study in which most BRAF-positive patients received targeted therapy during the last months of life. 13 However, those were patients with brain metastases only and the study also included therapy that started prior to the last 3 months of life.…”

“…Also, targeted therapy induces faster response and therefore also serves a palliative purpose in terms of quality of life preservation. 12,13 Starting or ending systemic therapy is complicated and often emotionally charged, especially when the patient is approaching the end of life. Decisions should be made through a well-informed assessment that considers patient and tumor characteristics, combined with the patient's and their family's preferences to optimize personalized care in the months before death.…”

Systemic melanoma therapy at the end of life: A single institutional retrospective study in Japan

“…However, some caveats remain concerning the excessive drug use in terminal-stage melanoma due to high expectations for their efficacy and tolerability. 1 , 2 , 3 , 4 , 5 The present study compared the use of anticancer agents in terminal-stage melanoma before and after the introduction of novel agents and identified factors associated with making decisions at the end of life (EOL), especially focused on the final 30 days of life. 1 , 2 , 3 , 4 …”

“… 1 , 2 , 3 , 4 , 5 The present study compared the use of anticancer agents in terminal-stage melanoma before and after the introduction of novel agents and identified factors associated with making decisions at the end of life (EOL), especially focused on the final 30 days of life. 1 , 2 , 3 , 4 …”