Abstract
Background: The use of chemotherapy near end of life (EOL) for various cancers is increasing and has been shown to be associated with delayed access to palliative care (PC) and increased aggressiveness in EOL care, without any benefit on survival. Methods: This retrospective study included 90 patients with metastatic non-small cell lung cancer (NSCLC) who received at least one line of palliative systemic anticancer therapy (SACT) and died between 1 November 2014, and 31 October 2016, at Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). Our primary objective was to evaluate the proportion of patients with NSCLC receiving SACT within 30 days of death. Secondary outcomes were to determine the mean and median delays between the administration of the last treatment and death, and to evaluate if there were differences in characteristics and outcomes (including overall survival (OS)) between patients treated or not within 30 days of death. Results: In our cohort, 22% of patients received SACT within 30 days of death. For the entire cohort, the mean delay between the last treatment and death was 94 days, and the median was 57 days. There were no statistically significant differences between the two groups in terms of baseline characteristics. Use of SACT near EOL was associated with decreased access to PC, higher rates of in hospital death, decreased use of medical aid in dying (MAiD), and a shorter median OS (4.0 vs. 9.0 months). Conclusions: In this retrospective cohort of patients with metastatic NSCLC, 22% of patients received SACT within 30 days of death, with a negative impact on access to PC, higher rates of in hospital death, decreased use of MAiD and palliative sedation, and a shorter median OS.
Highlights
Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death worldwide [1], with a 5-year survival of 19% [2]
Our study showed that patients receiving systemic anticancer therapies (SACTs) within 30 days of death had a significant shorter survival compared to patients who had their last treatment > 30 days before death (4.0 vs. 9.0 months)
The study was performed on patients treated between 2014 and 2016, before the widespread use of immunotherapy as a first-line treatment, as a monotherapy or in combination with chemotherapy. In this retrospective cohort of patients with metastatic non-small cell lung cancer (NSCLC) who received at least one line of palliative SACT and died between 2014 and 2016, 22% were treated within 30 days of death
Summary
Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death worldwide [1], with a 5-year survival of 19% [2]. In the last decade, targeted therapies with tyrosine kinase inhibitors (TKIs) have become standard first-line therapy for patients with driver oncogenes, with median survival in phase 3 trials beyond 3 years for patients with epidermal growth factor receptor (EGFR) mutations [5,6], and beyond 4 years for those with anaplastic lymphoma kinase (ALK) rearrangements [7,8] Another significant advance was the use of immunotherapy to target immune checkpoint pathways to prevent or reduce tumor-mediated immune suppression. Given the lack of recent literature on the subject, we sought to explore the use and impacts of SACT including chemotherapy, TKIs and immunotherapy near EOL, in patients with NSCLC. Secondary outcomes were to determine the mean and median delays between the administration of the last treatment and death, and to evaluate if there were differences in characteristics and outcomes (including OS) between patients treated or not within 30 days of death
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