Juline Auclair1, Stéphane Sanchez2, Jan Chrusciel2, Louise Hannetel3, Matthieu Frasca1, Guillaume Economos4, Raphaelle Habert-Dantigny5, Eduardo Bruera6, Benoit Burucoa1, Fiona Ecarnot7, Isabelle Colombet8, Cécile Barbaret9,10. 1. Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France. 2. Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France. 3. Department of Palliative Care, Hôpitaux Champagne Sud, Troyes, France. 4. Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Lyon-Sud, Lyon, France. 5. Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France. 6. Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 7. Department of Cardiology, University Hospital Besançon, University of Franche-Comté, EA392025000, Besançon, France. 8. Palliative Medicine, Cochin Hospital, APHP Centre, Paris, France. 9. Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France. cbarbaret@chu-grenoble.fr. 10. Laboratoire ThEMAS (Techniques pour l'évaluation et la Modélisation des Actions de Santé (TIMC-IMAG : Technique de l'Ingénierie Médicale et de la Compléxité-Informatique, Mathématiques et Applications, Grenoble), Grenoble, France. cbarbaret@chu-grenoble.fr.
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.
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.
Authors: Jennifer S Temel; Joseph A Greer; Alona Muzikansky; Emily R Gallagher; Sonal Admane; Vicki A Jackson; Constance M Dahlin; Craig D Blinderman; Juliet Jacobsen; William F Pirl; J Andrew Billings; Thomas J Lynch Journal: N Engl J Med Date: 2010-08-19 Impact factor: 91.245
Authors: Betty R Ferrell; Jennifer S Temel; Sarah Temin; Erin R Alesi; Tracy A Balboni; Ethan M Basch; Janice I Firn; Judith A Paice; Jeffrey M Peppercorn; Tanyanika Phillips; Ellen L Stovall; Camilla Zimmermann; Thomas J Smith Journal: J Clin Oncol Date: 2016-10-28 Impact factor: 44.544
Authors: Camilla Zimmermann; Nadia Swami; Monika Krzyzanowska; Breffni Hannon; Natasha Leighl; Amit Oza; Malcolm Moore; Anne Rydall; Gary Rodin; Ian Tannock; Allan Donner; Christopher Lo Journal: Lancet Date: 2014-02-19 Impact factor: 79.321
Authors: Risha Gidwani; Nina Joyce; Bruce Kinosian; Katherine Faricy-Anderson; Cari Levy; Susan C Miller; Mary Ersek; Todd Wagner; Vincent Mor Journal: J Palliat Med Date: 2016-05-26 Impact factor: 2.947