Anticancer therapy within the last 30 days of life: Results of an audit and re-audit cycle from a regional cancer center.

Abstract

e18260 Background: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. Methods: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to a hospital meeting and a quality improvement intervention program instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. Results: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. Conclusions: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and perceived better tolerability.

Impacts of multidisciplinary meeting case discussion on palliative care referral and end‐of‐life care in lung cancer: a retrospective observational study

“…In this study, high levels of hospital‐based care were delivered at the end of life. This is similar to figures from other centres, a recent systematic review demonstrating progressive increase in patients receiving aggressive inpatient care 10,32,33 . Reduced aggressive end‐of‐life care is a key quality of life indicator 34 .…”

“…This is similar to figures from other centres, a recent systematic review demonstrating progressive increase in patients receiving aggressive inpatient care. 10,32,33 Reduced aggressive end-of-life care is a key quality of life indicator. 34 Evidence suggests patients and families prefer less hospital-based care at the end of life with improved peace with death at home or in hospice.…”