Thirty-day mortality after systemic anticancer treatment as a real-world, quality-of-care indicator: the Northland experience.

Abstract

Systemic anticancer treatment (SACT) at the end of life is considered poor practice due to its futility and associated toxicities. Consequently, 30-day mortality after SACT is increasingly recognised as a potential real-world quality-of-care indicator in medical oncology. Whangarei Base Hospital (WBH) provides outpatient SACT treatment to all patients living in the Northland region of New Zealand. The goal of this study was to report our 30-day mortality after SACT and to contribute to the experience of its use in Australasia. In this retrospective study, the WBH electronic database was searched to identify all patients who had received SACT in WBH from 1 January 2012 to 31 December 2016. Patients who died within 30 days of their last treatment were shortlisted. Records were reviewed identifying key demographic, disease, treatment and mortality data. Composite 30-day mortality index and that of each tumour stream were calculated. Key findings were described using descriptive statistics. Over 5 years, 1103 patients received SACT in WBH, with 57 patients dying within 30 days of treatment, resulting in a composite 30-day mortality rate of 5.17%. One patient died receiving curative intent SACT. More deaths occurred in SACT-naïve patients and during the first two cycles of therapy. Of the deaths, 28% was attributed to SACT, while 59.7% was attributed to cancer progression. Thirty-day mortality rates were comparable to studies from larger institutions. We demonstrated the feasibility of this index for auditing practice in smaller oncology units over a longer timeframe.