Population‐based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia

Abstract

Background: Cancer treatment near end of life is not likely to add meaningful benefit and minimising intervention rates has been promoted as an indicator of quality of care. Population-based analysis of treatment allows comparative analysis of treatment rates and provides insight into patterns of care.Aims: To report a population-based analysis of both radiotherapy and active systemic therapy (AST) delivery rates along with patterns of treatment within the last 14 and 30 days of life.Methods: The Evaluation of Cancer Outcomes Registry records clinical information on all newly diagnosed cancer patients for the Barwon South West Region of Victoria, Australia. Diagnosis details, tumour type and stage as well as core treatment details and date of death were extracted for all patients diagnosed from 2009 to 2015 inclusive.Results: A total of 12 760 cases cancers were recorded. The median age of all cases was 68.8, and 53% were male. AST was received by 3699 (29%) of patients and radiotherapy by 3811 (30%). Patient deaths within 14 and 30 days of treatment for AST were 4.3 and 8.7%, respectively, and deaths within 14 and 30 days of treatment for radiotherapy 3.8 and 8.0% respectively. Factors associated with death within 30 days of AST and/or radiotherapy were male gender, age greater than 70 years and higher disease stage (all P < 0.01). Treatment rates within 30 days of death were highest for lung cancer (23% of cases) and lowest for breast cancer (2% of cases). Conclusions:This population-based analysis of AST and radiotherapy treatment within the last 30 days of life within a region of Australia has shown overall treatment rates below 10%. Treatment rates appear influenced by both patient and tumour characteristics. Future focus on subgroups with high rates of late intervention may help minimise treatment unlikely to add benefit. PC Ref/dead (%) PC Ref/alive (%) P-value Any treatment 30-day outcomes 317/608 (52) 1207/5190 (23) <0.01 Any treatment 14-day outcomes 135/299 (45) 1403/5595 (25) <0.01 Radiotherapy 30-day outcomes 184/309 (60) 878/3502 (25) <0.01 Radiotherapy 14-day outcomes 76/147 (52) 986/3664 (27) <0.01 Active systemic therapy 30-day outcomes 142/323 (44) 827/3376 (25) <0.01 Active systemic therapy 14-day outcomes 63/160 (39) 906/3539 (26) <0.01Population-based end-of-life care review

Early death after palliative radiation treatment: 30-, 35- and 40-day mortality data and statistically robust predictors

“…Despite progress in prognostic stratification, survival predictions in oncology tend to be overly optimistic [ 18 – 20 ]. Not all patients initially thought to represent suitable candidates for radiotherapy are able to complete their treatment.…”

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre

“…A review of published studies conducted in Australian and New Zealand is shown in Table 3. 5,[7][8][9][10][11][12][13][14] A retrospective study by Wein et al was excluded as their cohort consisted of patients who died during the 6-month study period rather than the number of patients who were treated with SACT. 15 In addition to our original study, 5 the studies most comparable to ours were performed by Zdenkowski et al 14 at Newcastle, 160 km for Sydney, and Ang et al 12 from Whangarei, 158 km for Auckland in New Zealand.…”

“…5,[7][8][9][10][11][12][13][14] A retrospective study by Wein et al was excluded as their cohort consisted of patients who died during the 6-month study period rather than the number of patients who were treated with SACT. 15 In addition to our original study, 5 the studies most comparable to ours were performed by Zdenkowski et al 14 at Newcastle, 160 km for Sydney, and Ang et al 12 from Whangarei, 158 km for Auckland in New Zealand. All were conducted at a single site, the timeframe of the studies ranged from 36 to 60 months, the cohorts from 1103 to 1709 patients, and the median age of patients from 63.5 to 68 years.…”

“…A review of published studies conducted in Australian and New Zealand is shown in Table 3. 5,7–14 A retrospective study by Wein et al. was excluded as their cohort consisted of patients who died during the 6-month study period rather than the number of patients who were treated with SACT.…”

How aging of the global population is changing oncology

“…As the cohort of older adults with cancer enlarges, a widening spectrum of patient fitness versus frailty is to be expected [ 55 ], complicating therapeutic decision-making. A controversy often raised in this context is that the costliest phase of care tends to be the last year [ 56 , 57 ], with even older patients often being prescribed anticancer therapy in the last month of life [ 58 – 60 ]. The solution to this would not seem to lie in implementing policies based on age, which is an unreliable predictor of health status [ 61 ], but in applying functional measures [ 62 ].…”