Identification of factors associated with aggressive end-of-life antitumour treatment: retrospective study of 1282 patients with cancer

Abstract

ObjectiveAntitumour treatment in the last 2 weeks of death (ATT-W2) and a new regimen of ATT within 30 days of death (NATT-M1) are considered as aggressive end-of-life (EOL) care. We aimed to assess factors associated with inappropriate use of antitumour treatment (ATT) at EOL.MethodsData of patients with cancer who died in 2013, 2015, 2017 and 2019 in a single for-profit cancer centre were retrospectively analysed. ATT was divided into chemotherapy (CT), oral targeted therapy (OTT), hormonotherapy and immunotherapy (IMT).ResultsA total of 1282 patients were included. NATT-M1 was given to 197 (15.37%) patients, and 167 (13.03%) had an ATT-W2. Patients with a performance status of <2 and treated with CT had more both ATT- W2 (OR=2.45, 95% CI 1.65 to 3.65, and OR=10.29, 95% CI 4.70 to 22.6, respectively) and NATT-M1 (OR=2.01, 95% CI 1.40 to 2.90, and OR=8.41, 95% CI 4.46 to 15.86). Predictive factors of a higher rate of ATT-W2 were treatment with OTT (OR=19.08, 95% CI 7.12 to 51.07), follow-up by a medical oncologist (OR=1.49, 95% CI 1.03 to 2.17), miscellaneous cancer (OR=3.50, 95% CI 1.13 to 10.85) and length of hospital stay before death of <13 days (OR=1.92, 95% CI 1.32 to 2.79). Urinary tract and male genital cancers received less ATT-W2 (OR=0.38, 95% CI 0.16 to 0.89, and OR=0.40, 95% CI 0.16 to 0.99) and patients treated by IMT or with age <69 years more NATT-M1 (OR=19.21, 95% CI 7.55 to 48.8, and OR=1.69, 95% CI 1.20 to 2.37). Patients followed up by the palliative care team (PCT) had fewer ATT-W2 and NATT-M1 (OR=0.49, 95% CI 0.35 to 0.71, and OR=0.42, 95% CI 0.30 to 0.58).ConclusionsMost recent ATT and access to a PCT follow-up are the two most important potentially modifiable factors associated with aggressive EOL in patients with cancer. Early integrated palliative oncology care could help to decrease futile ATT at EOL.

PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life

“…Overall, 177 (29%) patients received anticancer therapy in the last 3 months of life (intervention: 79 [45%], control: 98 [55%]). Median time from diagnosis until death was 6 months (IQR [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The majority (35%) had pancreatic cancer.…”

“…7 Registry-based studies have shown that close to 20% received anticancer therapy in the last two weeks of life, 8 most often in centres with no specialised palliative care units. 4,9 No RCTs on integration of oncology and specialised palliative care use anticancer therapy as the primary endpoint, despite reported associations with poorer quality of life and hastened death 2 and although indices of less use have been reported as secondary outcomes. 10,11 Most publications on end-of-life anticancer therapy are retrospective cohort analyses from single-or multi-institutional studies 2,9,12,13 or registry reports 8,[14][15][16] suggesting that palliative care and patient-centred care may reduce aggressive end-of-life treatment.…”

“… 7 Registry-based studies have shown that close to 20% received anticancer therapy in the last two weeks of life, 8 most often in centres with no specialised palliative care units. 4 , 9 …”