1307P - Use of treatments of questionable benefit in hospitalized patients with metastatic gastric or esophageal cancer near the end of life. A country-wide, register-based study

Abstract

The benefit of life-prolonging treatments in terminally ill cancer patients is debated. Little is know, however, about the aggressiveness of care in patients with metastatic esophagus or stomach cancer. Register-based study in France, including all hospitalized adults (≥20 years) who died as the result of metastatic esophageal or gastric cancer between 2010 and 2013. The receipt of chemotherapy and the use of artificial nutrition during the last 3 months of life were defined as primary outcomes. 4,031 patients with metastatic esophageal cancer and 10,423 patients with metastatic gastric cancer were included (n total= 14,454). Overall, 47.6% of patients received chemotherapy in their last 3 months of life, with a significant decrease over time (from 35.9% during the third month before death to 7.9% in the final week of life). In contrast, the receipt of artificial nutrition rose from 9.4% to 16% over the same period of time. This increase in the use of artificial nutrition was observed for both esophagus and stomach cancer, across all age-groups, and regardless of the number of chronic comorbidities (p > 0.001 for trend). During the last week before death, the likelihood of receiving artificial nutrition decreased with age (adjusted OR= 0.80, 95%CI= 0.77-0.84 for each 10-year increase in age), and was significantly higher for patients with esophageal cancer compared with gastric cancer (adjusted OR= 1.25, 95%CI= 1.13-1.37). In addition, 3.5% of patients received invasive ventilation during the last month before death (5% of patients with esophageal cancer and 3% of patients with gastric cancer, p < 0.001). 6% of patients eventually died in Intensive Care Units, and only 12.6% died in Palliative Care Units. Our study shows that hospitalized patients with metastatic esophageal or gastric cancer are likely to receive treatments of questionable benefit near the end of life. Interventional studies focusing on patient reported outcomes are needed to assess the clinical benefit of artificial nutrition for patients with terminal cancer.