Many Patients with Cancer Still Receiving Chemotherapy at End of Life

A study found that patients with cancer at end of life (defined as last two weeks of life) may be receiving chemotherapy when supportive care would be a more appropriate option. The results of the study were presented by Yasemine Anounty, PharmD, a post-graduate year 2 hematology-oncology pharmacy resident at the University of California (UC) San Diego Health, at HOPA’s 16th Annual Conference.

Researchers retrospectively assessed data for 149 adults (mean age, 59 years) receiving 160 intravenous cancer-directed therapy regimens (cytotoxic chemotherapy, monoclonal antibodies, and immunotherapy) in the UC San Diego Health inpatient setting between January 1, 2016, and June 30, 2019, who died within 30 days of administration. Patients receiving chemotherapy as part of a conditioning regimen for bone marrow transplant or chimeric antigen receptor T-cell therapy, or who were part of clinical trials, were excluded.

Most patients (n=95; 59%) had hematologic malignancies, while 65 (41%) had solid tumors. The most common types of cancer were leukemia (n=44; 28%) and lymphoma (n=40; 25%). Most patients (n=53; 33%) had an Eastern Cooperative Oncology Group performance status score of three.

A total of 28 patients (19%) were planned admissions for cancer-directed therapy, and 41 (28%) received three or more prior lines of therapy at the time of treatment. Twenty-two patients (15%) were receiving intensive care unit level of care, and 41 (28%) were do not resuscitate full care.

In the cohort, patients died a mean 14 days after receiving cancer-directed therapy, and two patients died on the day of treatment.

Predictors of early death (defined as one to seven days after treatment) at the time of cancer-directed therapy were albumin <3 g/dL and hepatic dysfunction. Positive microbiology cultures at the time of treatment also significantly increased the odds of early death (within one to seven days after treatment) compared with death within eight to 14 days after treatment (odds ratio, 0.185; 95% confidence interval, 0.034-0.999).

The study is limited by its retrospective, single-center design and small patient population.

The researchers said larger multicenter, prospective studies are needed to validate the findings and develop a standardized treatment approach for those with a poor prognosis.

Anouty Y, Saunders IM, Block S, et al. Cancer directed therapy at the end of life, a retrospective review. Presented at HOPA 16th Annual Conference. March 2020, Tampa, Florida.