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MA19 - Looking at PROs in Greater Detail - What Patients Actually Want and Expect (ID 147)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:Joaquim Bosch-Barrera, Virginia Calvo De Juan
- Coordinates: 9/10/2019, 11:30 - 13:00, Interlaken (1988)
MA19.11 - Population Based Analysis of End of Life Treatment Patterns in Thoracic Malignancies (Now Available) (ID 1154)
11:30 - 13:00 | Author(s): Peter Eastman
Active cancer treatment within the last month of life is unlikely to meaningfully benefit patients and ASCO guidelines recommend chemotherapy treatment rates be kept as low as possible. Patients with thoracic malignancies often have rapidly progressive disease and significant symptom burden and there is little population based data on patterns of care near end of life.Method
The Evaluation of Cancer Outcomes Registry records clinical information on all newly diagnosed cancer patients within a region of Victoria, Australia. Core diagnostic, demographic, treatment and outcome details were extracted for all patients diagnosed from 2009-2015 with death data through to end of 2016. Patients with thoracic malignancies were further analysed for treatment patterns at end of life. Details of palliative radiotherapy (pRT) and active systemic treatment (AST – intravenous chemotherapy, targeted therapy and/or immunotherapy) were recorded for all patients. Details on oral chemotherapy and stereotactic radiotherapy were not recorded.Result
The total cohort during the study period comprised 12760 patients. Of these, 1328 patients were recorded with a thoracic malignancy (TM) (non small cell lung cancer 82%, small cell lung cancer 10%, mesothelioma 7%) and 1118 of these died. At total of 39% (518) and 41% (538) of the 1328 TM patients received AST and pRT respectively at some point. Of these patients 15% (77/518) received AST and 23% (121/538) pRT within 30 days of death, compared with 7.0% (242/3436) (p<0.01) and 19% (178/965) (p=0.06) respectively for the total cohort excluding TM patients. Patients receiving AST within 30 days of death had a similar median age (66.7 vs. 67.8 years, p=NS) but shorter median survival from diagnosis (146 v. 281 days, p<0.01) than patients receiving final AST within 1-6 months. The frequency of some change in AST agents within the prior month was highest in the last month of life. The most common AST agents used in the final month of life were pemetrexed, etoposide and gemcitabine and most patients were treated with single agents. More pRT treatments were started in the last 30 days of life than in any other month near end of life. Patients receiving pRT in the last month of life also had a shorter median survival from diagnosis (113 v. 215 days, p<0.01) and the sites most commonly treated with pRT in the last month of life were chest/lung, spine and whole brain.Conclusion
Patients with thoracic malignancies have higher rates of AST treatment within the last 30 days of life than other patients with cancer in the same geographic region. Those treated within 30 days of death also have shorter median overall survival and higher frequencies of changing AST agents or starting pRT, possibly suggesting aggressive, symptomatic and poorly responding disease.
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