Abstract
IntroductionVery 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 methodsWe 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.ResultsIn 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.ConclusionChemotherapy use near the end-of-life was common, which might negatively impact patient quality of life.
Highlights
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
We explore the real-life use of chemotherapy near the end-of-life and the characteristics of MBC patients treated at this stage in areas of Sweden (Stockholm) and Greece (Athens and Heraklion), in order to highlight possible factors that could help in decision-making and identify cultural differences between Northern and Southern Europe that may drive palliative care
This is a retrospective cohort study whose primary objective was to describe the contemporary use of futile chemotherapy among patients with MBC, defined in this study as chemotherapy administered within the last 30 days of the patient’s life
Summary
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. It is important to note that the heavily pretreated MBC population likely differs from that of patients enrolled in clinical trials, the latter generally being fit, younger and without significant comorbidities This poses a difficulty in translating results from clinical trials to the general MBC population where the observed median OS is shorter [8], and clearly supports a need to gain knowledge about real-life use of chemotherapy in late-stage MBC. This lack of evidence and consistent clinical guidelines may expose patients to unnecessarily aggressive and futile treatment, which can negatively impact the patients’ quality of life [9]
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