National trends in end of life care for veterans with advanced cancer.

Smith, Claire; Coke, Pat; Kluger, Monica; Kamal, Arif H.; Kelley, Michael J.

doi:10.1200/jco.2018.36.30_suppl.3

Cited by 2 publications

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“…In MSS colon cancer, prior literature has described no change in use of cytotoxic chemotherapy at the EOL. 28,29 Therefore, we hypothesized that in contrast to cancer types for which ICIs have been FDA approved, there has been no significant change in use of systemic therapy in MSS colon cancer at the EOL during the study time period.…”

Section: Introductionmentioning

confidence: 99%

The adoption of immune checkpoint inhibitors and patterns of care at the end of life.

Riaz

Gan

Li³

et al. 2020

JCO

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12027 Background: As immune checkpoint inhibitors (ICIs) have transformed the care of patients with cancer, it is unclear whether treatment at end of life (EOL) has changed. Because aggressive therapy at EOL is associated with increased costs and patient distress, we explored the association between the FDA approvals of ICIs and treatment patterns at EOL. Methods: We conducted a retrospective, observational study using patient-level data from the Flatiron health EHR-derived de-identified database. Patients had advanced melanoma, non-small cell lung cancer (NSCLC) (cancer types with an ICI indication) or microsatellite stable (MSS) colon cancer (a cancer type without an ICI indication) and died between 2013 and 2017. We calculated annual proportions of decedents who received systemic cancer therapy in the final 30 days of life and used logistic regression to model the association between the post-ICI Federal Drug Administration (FDA) approval time period and use of systemic therapy at EOL, adjusting for patient characteristics. We also assessed the use of chemotherapy or targeted/biologic therapies at EOL, before and after FDA approval of ICIs using Pearson Chi Square test. Results: There was an increase in use of EOL systemic cancer therapy in the post-ICI approval period for both melanoma (33.9% to 43.2%, p-value < 0.001) and NSCLC (37.4% to 40.3%, p-value < 0.001). In contrast, the control group of decedents with MSS colon cancer demonstrated no significant increase in use of systemic therapy at EOL. After controlling for patient characteristics, there was a significantly higher odds of receiving systemic treatment at EOL in the post-ICI time period compared to the pre-ICI time period in melanoma (OR 1.42, 95% CI 1.09-1.86, p-value < 0.001) and NSCLC (OR 1.13, 95% CI 1.06-1.20, p value < 0.001), with no significant difference in receipt of systemic therapy in patients with MSS colon cancer. After FDA approval of ICIs, patients with NSCLC and melanoma had a decrease in the use of chemotherapy, with a concomitant increase in use of ICIs at EOL. Decedents with MSS colon cancer did not have a statistically significant change in use of chemotherapy or targeted/biologic therapies during the study period. Conclusions: The adoption of ICIs was associated with a substantive increase in the use of systemic therapy at EOL in melanoma, and a smaller yet significant increase in NSCLC.

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Section: Introductionmentioning

confidence: 99%

The adoption of immune checkpoint inhibitors and patterns of care at the end of life.

Riaz

Gan

Li³

et al. 2020

JCO

View full text Add to dashboard Cite

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Adoption of Immune Checkpoint Inhibitors and Patterns of Care at the End of Life

Riaz¹,

Gan

et al. 2020

JCO Oncology Practice

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PURPOSE: As immune checkpoint inhibitors (ICIs) have transformed the care of patients with cancer, it is unclear whether treatment at the end of life (EOL) has changed. Because aggressive therapy at the EOL is associated with increased costs and patient distress, we explored the association between the Food and Drug Administration (FDA) approvals of ICIs and treatment patterns at the EOL. METHODS: We conducted a retrospective, observational study using patient-level data from a nationwide electronic health record–derived database. Patients had advanced melanoma, non–small-cell lung cancer (NSCLC; cancer types with an ICI indication), or microsatellite stable (MSS) colon cancer (a cancer type without an ICI indication) and died between 2013 and 2017. We calculated annual proportions of decedents who received systemic cancer therapy in the final 30 days of life, using logistic regression to model the association between the post-ICI FDA approval time and use of systemic therapy at the EOL, adjusting for patient characteristics. We assessed the use of chemotherapy or targeted/biologic therapies at the EOL, before and after FDA approval of ICIs using Pearson chi-square test. RESULTS: There was an increase in use of EOL systemic cancer therapy in the post-ICI approval period for both melanoma (33.9% to 43.2%; P < .001) and NSCLC (37.4% to 40.3%; P < .001), with no significant change in use of systemic therapy in MSS colon cancer. After FDA approval of ICIs, patients with NSCLC and melanoma had a decrease in the use of chemotherapy, with a concomitant increase in use of ICIs at the EOL. CONCLUSION: The adoption of ICIs was associated with a substantive increase in the use of systemic therapy at the EOL in melanoma and a smaller yet significant increase in NSCLC.

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National trends in end of life care for veterans with advanced cancer.

Cited by 2 publications

References 0 publications

The adoption of immune checkpoint inhibitors and patterns of care at the end of life.

The adoption of immune checkpoint inhibitors and patterns of care at the end of life.

Adoption of Immune Checkpoint Inhibitors and Patterns of Care at the End of Life

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