1378P Is 30-day mortality after systemic anticancer therapy in lung cancer in the era of varied treatments still relevant?

Abstract

Death within 30 days of systemic anticancer therapy (SACT) is a national benchmark of quality of care in England. This metric has mobilised changes in the delivery of Acute Oncology Services in the country. However, varying treatments with chemotherapy, immunotherapy and Tyrosine kinase inhibitors (TKIs) might influence clinical decision making and thereby mortality rates. This is the first study to analyse 30-day mortality after lung cancer SACT according to all treatment types. From Jan 2016-Dec 2018, a search for cycles of SACT for lung cancer returned 5294 entries. Data cleaning identified 367 (2016), 373 (2017) and 418 (2018) unique patient-SACT treatment type combinations annually. These treatments were received by 344 (2016), 356 (2017) and 389 (2018) unique patients respectively. All deaths within 30 days of SACT are reviewed in a multidisciplinary (MDT) mortality meeting. Descriptive statistics were used. 38 patients died within 30 days of SACT over 3 years. 7/38 (18%) patients died due to treatment related causes, and in 2 of these case death was attributed to neutropenic sepsis. 17/38 (45%) patients died due to progressive disease and 14/38 (45%) of patients died due to medical co-morbidities. The annual 30-day SACT mortality rates for 2016 to 2018 increased from 2.6% (9/344), 3.4% (12/356) to 4.4% (17/389). The 30-day mortality for chemotherapy was 2.6% unchanged from 2016 to 2018. 30-day mortality for immunotherapy showed variability from 9% (2016) to 3.4% (2017) to 4.3% (2018). However, TKI associated 30-day mortality increased from 0% (2016), to 6.8% (2017) to 12% (2018). All deaths on TKI were due to disease progression or co morbidities. Learning points were identified in 5/38 cases (13%) after MDT review. The changing landscape of SACT in lung cancer impacts 30-day SACT mortality rates, reflecting difficulties in predicting immunotherapy toxicity and decisions around TKI cessation. 30-day SACT mortality must consider trends and treatment types to be meaningful benchmarks that lead to appropriate service changes.