Abstract
BackgroundThe benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. We aimed to evaluate the overall survival, factors associated with early mortality, and adoption of additional procedures in hospitalized patients with advanced cancer and poor ECOG-PS treated with PC.MethodsWe analyzed a retrospective cohort of patients with advanced cancer treated with PC during hospitalization at an academic cancer center in Brazil from 2014 to 2016. Eligibility criteria included: ECOG-PS 3–4 and start of first-line PC; or ECOG-PS ≥ 2 and start of second or subsequent lines. Primary endpoint was 30-day survival from start of PC. Kaplan-Meier method was used for survival estimates and Cox regression for factors associated with 30-day mortality.ResultsTwo hundred twenty-eight patients were eligible. 21.9, 66.7 and 11.4% of patients had ECOG-PS 2, 3 and 4, respectively. 49.6% had gastrointestinal tumors. Median follow-up was 49 days (range 1–507). 98.2% of patients had died, 32% during the index hospitalization. The 30-day and 60-day survival rates were 55.7 and 38.5%, respectively. 30% of patients were admitted to the intensive care unit. In a multivariable analysis, ECOG-PS 3/4 (HR 2.01; P = 0.016), hypercalcemia (HR 2.19; P = 0.005), and elevated bilirubin (HR 3.17; P < 0.001) were significantly associated with 30-day mortality.ConclusionsPatients with advanced cancer and poor ECOG-PS had short survival after treatment with inpatient PC. Inpatient PC was associated with aggressive end-of-life care. Prognostic markers such as ECOG-PS, hypercalcemia and elevated bilirubin can contribute to the decision-making process for these patients.
Highlights
The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging
We aimed to evaluate the outcomes of patients with advanced cancer and poor Eastern Cooperative Oncology Group Performance Status (ECOG-PS) treated with inpatient PC, including the overall survival, factors associated with early mortality, and the rate of invasive procedures performed
Our results showed that hospitalized patients with advanced cancers and poor performance status had a low survival rate after receiving PC
Summary
The benefit of palliative chemotherapy (PC) in patients with advanced solid tumors and poor performance status (ECOG-PS) has not been prospectively validated, which makes treatment decision challenging. The American Cancer Society of Clinical Oncology (ASCO) previously published recommendations against the use of cancer-directed therapy for patients with solid tumors and poor ECOG-PS (i.e., ECOG-PS ≥ 3 defined as “capable of only limited self-care, confined to bed or chair more than 50% of walking hours”) [5]. This was based on the limited inclusion of these patients in clinical trials as well as observational studies correlating poor ECOG-PS to lower response rate, poor treatment tolerance and shorter overall survival [5,6,7]. This guideline considers a 30-day mortality rate of 20–50% to be excessive
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