Chemotherapy use near the end-of-life in patients with metastatic breast cancer

Abstract

Introduction Very few data are available regarding the use of chemotherapy in patients with metastatic breast cancer (MBC) near the end-of-life, i.e., the final month. The aim of this study was to provide a descriptive analysis of its use in two different European geographic areas (Sweden and Greece). Materials and methods We retrospectively collected data regarding clinicopathologic characteristics, survival, and use of chemotherapy during the final 30 days of life using two sources: for the Swedish cohort, patients who were diagnosed with MBC in 2010–2015 were identified from the Stockholm-Gotland population-based Breast Cancer Registry and treatment data were collected using hospital charts. For the Greek cohort, patients with MBC were identified from hospital charts at two hospitals in Athens and Crete. Results In the Swedish cohort, 1571 patients were identified; median overall survival was 16.96 months (95% CI 15.4–18.4). 23.2% of patients were treated with chemotherapy during the final month of life, with higher rates among patients ≤ 60 years (p < 0.001). Per OS monotherapy such as capecitabine or vinorelbine was most commonly used. In contrast, median OS in the Greek cohort (n = 966) was 49.8 months (95% CI 45.6–54.1) and 46.5% of patients received chemotherapy at the end-of-life, most commonly intravenous drug combinations. In multivariable analysis, age and albumin levels were statistically significantly associated with chemotherapy use in the Swedish cohort. Conclusion Chemotherapy use near the end-of-life was common, which might negatively impact patient quality of life.

Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer

“…This observation fits in with two studies describing fewer end of life treatment discussions and more use of health care resources including chemotherapy in southern European countries (Italy and Spain) compared to northern European countries (Belgium and The Netherlands) [24,31]. Other factors related to more chemotherapy prescriptions shortly before death in ABC were younger age [29,30], higher albumin levels [29], greater disease burden [30], more prior lines of chemotherapy [30], and in this study we found HR−/HER2− breast cancer, and survival time <1 year as related factors. Larger hospital size was associated with fewer chemotherapy prescription shortly before death in the Dutch GI cancer study [25].…”

“…In our study, 9% of ABC patients received a new line of chemotherapy in the final 30 days of life and 21% of the patients received ongoing chemotherapy in the final 14 days of life. Several other breast cancer studies have reported the rate of chemotherapy administration within 14 days before death, ranging from 10% to 24% in US, French and Swedish populations [ 20 , 21 , 29 , 30 ] and 49% in a Greek ABC population [ 29 ]. Our rate of new chemotherapy within 30 days before death was comparable to findings in a Swedish population (8%), although in a Greek population, 20% of patients received a new line of chemotherapy [ 29 ].…”

“…Several other breast cancer studies have reported the rate of chemotherapy administration within 14 days before death, ranging from 10% to 24% in US, French and Swedish populations [ 20 , 21 , 29 , 30 ] and 49% in a Greek ABC population [ 29 ]. Our rate of new chemotherapy within 30 days before death was comparable to findings in a Swedish population (8%), although in a Greek population, 20% of patients received a new line of chemotherapy [ 29 ]. This observation fits in with two studies describing fewer end of life treatment discussions and more use of health care resources including chemotherapy in southern European countries (Italy and Spain) compared to northern European countries (Belgium and The Netherlands) [ 24 , 31 ].…”

Women with short survival after diagnosis of metastatic breast cancer: a population-based registry study

“…Despite therapeutic advances and significant improvements in prognosis according to controlled clinical trials [ 7 – 12 ], the improvement of overall survival of MBC at population level is less pronounced [ 13 ]. For example, in a resource-rich setting, as is the case in the Stockholm–Gotland region in Sweden, where screening, treatment, and surveillance are available to all women irrespective of socioeconomic status and health insurance, overall survival (OS) has stagnated over the past decades [ 14 , 15 ]. Accordingly, in a recent meta-analysis 12 out of 15 studies showed improvement in unadjusted survival over time; however, in only 3 of 10 studies the improvement remained significant at multivariate analysis adjusting for potential confounding variables [ 16 ].…”

Objective Response to First-Line Treatment as a Predictor of Overall Survival in Metastatic Breast Cancer: A Retrospective Analysis from Two Centers over a 25-Year Period

“…The introduction of effective targeted agents, such as inhibitors of cyclin dependent kinases 4 and 6 (CDK4/6i), and antibodies against the human epidermal growth factor receptor 2 (HER2) has led to unprecedented outcomes with reported median overall survival (OS) up to 5 years in certain patient subgroups [2, 3]. However, patient selection in clinical trials might be one of the driving forces behind the reported outcomes [4], which are not replicated in population-based studies that demonstrate a much shorter and relatively stable OS during the past 30 years [5, 6]. Another possible contributor to this lack of improvement in the real-world clinical setting is the decreased efficacy of subsequent chemotherapy lines [7], a fact that complicates the interpretation of this setting of studies conducted at an earlier stage.…”