Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital

Auclair, J.; Sanchez, Stéphane; Chrusciel, Jan; Hannetel, Louise; Frasca, Matthieu; Economos, Guillaume; Habert-Dantigny, Raphaelle; Bruera, Éduardo; Burucoa, Benoît; Ecarnot, Fiona; Colombet, Isabelle; Barbaret, Cécile

doi:10.1007/s00520-022-06901-1

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…There is evidence that patients with advanced cancer may be more risk-taking than healthy individuals and willing to undergo treatments with major toxicity even for small bene ts [23]. Additionally, the constantly evolving therapy options in uence decision-making towards active treatment, hazarding the timely integration of palliative care as shown in general but also speci cally for lung cancer patients since the introduction of immunotherapies [24,25].…”

Section: Resultsmentioning

confidence: 99%

Exploring personal values of patients with advanced lung cancer in the hospital setting: a mixed-methods study

Villalobos,

Ludwig,

König

et al. 2024

Preprint

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Purpose Guidelines recommend the discussion of treatment and care goals of patients with advanced cancer according to their values and preferences. Little is known about the value system of these patients and how to address them in the hospital setting. Methods Convergent mixed-methods design: collection of quantitative data of patients with advanced lung cancer from a German University Hospital (n = 66) using the Human Values Scale, group comparison after a propensity score matching with the German cohort of the 9th European Social Survey, semi-structured interviews (n = 17) and qualitative content analysis, integration of data using side-by-side display. Results Quantitative analysis shows that lung cancer patients prioritize significantly more the value dimensions of self-transcendence (universalism, benevolence; p = .02) and openness to change (self-direction, stimulation; p = .03). While values of conservation (conformity, tradition, security; p = .04) and self-enhancement (power, achievement; p = .02) are notably less important. Besides the affirmation of self-direction, qualitative data, contrastingly, shows strong “conformity” with medical treatment decisions and the importance of “security”, while revealing the systematic neglect of values in patient-physician conversations. Conclusions The values guiding lung cancer patients differ from the general population. Despite the expressed importance of self-direction strong conformity arises in regard to medical treatment decisions. This may show the need of feeling secure in a complex and uncertain setting but has also the risk of over-treatment, hazarding goal-concordant care and the timely integration of palliative care, particularly when considering the neglect of values exposed.

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Section: Resultsmentioning

confidence: 99%

Exploring personal values of patients with advanced lung cancer in the hospital setting: a mixed-methods study

Villalobos,

Ludwig,

König

et al. 2024

Preprint

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“…Immunotherapy near the end of life (EOL) has been associated with increased hospitalization rates, increased emergency department visits, higher chance of hospital death, decreased hospice enrollment, delayed palliative care referral, financial toxicity, and poor performance status . In contrast to chemotherapy, which has seen decreased utilization at the EOL in recent years, evidence suggests that immunotherapy is increasingly being administered near death for patients with cancer .…”

Section: Introductionmentioning

confidence: 99%

“…mmunotherapy near the end of life (EOL) has been associated with increased hospitalization rates, increased emergency department visits, higher chance of hospital death, decreased hospice enrollment, delayed palliative care referral, financial toxicity, and poor performance status. [1][2][3][4][5] In contrast to chemotherapy, which has seen decreased utilization at the EOL in recent years, evidence suggests that immunotherapy is increasingly being administered near death for patients with cancer. 1,[5][6][7][8] Recent studies have reported that 18% to 33% of patients with a wide range of cancers received immunotherapy within 30 days of death-exceeding for the first time in 2019 the proportion receiving chemotherapy in their last 30 days.…”

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confidence: 99%

Immunotherapy Initiation at the End of Life in Patients With Metastatic Cancer in the US

Kerekes,

Frey,

Prsic

et al. 2024

JAMA Oncol

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ImportanceWhile immunotherapy is being used in an expanding range of clinical scenarios, the incidence of immunotherapy initiation at the end of life (EOL) is unknown.ObjectiveTo describe patient characteristics, practice patterns, and risk factors concerning EOL-initiated (EOL-I) immunotherapy over time.Design, Setting, and ParticipantsRetrospective cohort study using a US national clinical database of patients with metastatic melanoma, non–small cell lung cancer (NSCLC), or kidney cell carcinoma (KCC) diagnosed after US Food and Drug Administration approval of immune checkpoint inhibitors for the treatment of each disease through December 2019. Mean follow-up was 13.7 months. Data analysis was performed from December 2022 to May 2023.ExposuresAge, sex, race and ethnicity, insurance, location, facility type, hospital volume, Charlson-Deyo Comorbidity Index, and location of metastases.Main Outcomes and MeasuresMain outcomes were EOL-I immunotherapy, defined as immunotherapy initiated within 1 month of death, and characteristics of the cohort receiving EOL-I immunotherapy and factors associated with its use.ResultsOverall, data for 242 371 patients were analyzed. The study included 20 415 patients with stage IV melanoma, 197 331 patients with stage IV NSCLC, and 24 625 patients with stage IV KCC. Mean (SD) age was 67.9 (11.4) years, 42.5% were older than 70 years, 56.0% were male, and 29.3% received immunotherapy. The percentage of patients who received EOL-I immunotherapy increased over time for all cancers. More than 1 in 14 immunotherapy treatments in 2019 were initiated within 1 month of death. Risk-adjusted patients with 3 or more organs involved in metastatic disease were 3.8-fold more likely (95% CI, 3.1-4.7; P &lt; .001) to die within 1 month of immunotherapy initiation than those with lymph node involvement only. Treatment at an academic or high-volume center rather than a nonacademic or very low-volume center was associated with a 31% (odds ratio, 0.69; 95% CI, 0.65-0.74; P &lt; .001) and 30% (odds ratio, 0.70; 95% CI, 0.65-0.76; P &lt; .001) decrease in odds of death within a month of initiating immunotherapy, respectively.Conclusions and RelevanceFindings of this cohort study show that the initiation of immunotherapy at the EOL is increasing over time. Patients with higher metastatic burden and who were treated at nonacademic or low-volume facilities had higher odds of receiving EOL-I immunotherapy. Tracking EOL-I immunotherapy can offer insights into national prescribing patterns and serve as a harbinger for shifts in the clinical approach to patients with advanced cancer.

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The Cost of Cancer Care at the End of Life: Implications for Centers for Medicare and Medicaid Services and for Radiation Oncology

2023

International Journal of Radiation Oncology*Biology*Physics

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Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital

Cited by 6 publications

References 38 publications

Exploring personal values of patients with advanced lung cancer in the hospital setting: a mixed-methods study

Exploring personal values of patients with advanced lung cancer in the hospital setting: a mixed-methods study

Immunotherapy Initiation at the End of Life in Patients With Metastatic Cancer in the US

The Cost of Cancer Care at the End of Life: Implications for Centers for Medicare and Medicaid Services and for Radiation Oncology

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