Abstract
Background
Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, but their use near the end of life in patients with advanced cancer is poorly documented. This study investigated the association between administration of ICI therapy in the last month of life and the duration of involvement of the palliative care (PC) team, among patients with advanced cancer who died in-hospital.
Methods
In a retrospective, multicentre study, we included all patients who died in 2018 of melanoma, head and neck carcinoma, non-small cell lung cancer or urothelial or renal cancer, in 2 teaching hospitals and one community hospital in France. The primary outcome was the association between ICI therapy in the last month of life and duration of involvement of the PC team in patient management.
Results
Among 350 patients included, 133 (38%) received anti-cancer treatment in the last month of life, including 71/133 (53%) who received ICIs. A total of 207 patients (59%) received palliative care, only 127 (36%) 30 days before death. There was a significant association between ongoing ICI therapy in the last month of life and shorter duration of PC management (p = 0.04). Receiving ICI therapy in the last month of life was associated with an increased risk of late PC initiation by multivariate regression analysis (hazard ratio 1.668; 95% CI 1.022–2.722).
Conclusion
ICI therapy is frequently used close to the end of life in patients with advanced cancer. Innovative new anti-cancer treatments should not delay PC referral. Improved collaboration between PC and oncological teams is needed to address this issue.
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Availability of data and materials
Our data are only available on request due to legal restrictions. Indeed, the data are the property of the University Hospital of Grenoble, France. To access our data, a written request must be addressed to our administration at the following email address: accueilrecherche@chu-grenoble.fr.
Code availability
Not applicable.
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Study concept: JA, CB.
Study design: JA, CB, SS, IC, MF.
Data acquisition: JA, CB, BB, SS, LH.
Data analysis and interpretation: SS, JC, JA, CB, EB.
Statistical analysis: SS, JC.
Manuscript preparation: JA, CB, FE, SS, IC, RHD, GE, EB, MF.
Providing language help: FE, EB.
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Auclair, J., Sanchez, S., Chrusciel, J. et al. Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital. Support Care Cancer 30, 4997–5006 (2022). https://doi.org/10.1007/s00520-022-06901-1
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DOI: https://doi.org/10.1007/s00520-022-06901-1