Novel Systemic Anticancer Treatments and Health Services Use at the End of Life Among Adults With Cancer
Menée au Canada à partir de données portant sur 18 337 patients atteints d'une tumeur solide ou d'un cancer hématologique, cette étude analyse l'utilisation de nouveaux agents anticancéreux systémiques dans les 5 années précédant le décès et évalue l'association entre cette utilisation et le recours aux services de santé en fin de vie (consultations aux urgences, hospitalisations, admissions dans des services de soins intensifs)
Purpose: Use of chemotherapy at the end of life (EOL) is discouraged, but evidence to guide decisions on the use of novel systemic anticancer treatment (SACT) agents is lacking. We examined trends of use among SACT types and association with health services use at the EOL.
Materials and Methods: We analyzed Canadian Ontario Cancer Registry data for adults diagnosed with solid tumors or hematologic malignancies within 5 years of death who received SACT between March 2015 and March 2021. Receipt of SACT in the last 30 days of life was categorized as chemotherapy alone, chemotherapy and immunotherapy, immunotherapy alone, and targeted therapy alone. Outcomes included high health services use, including multiple (≥2) emergency department (ED) visits, multiple (≥2) hospitalizations, or any (≥1) intensive care unit admission, and hospital deaths. Segmented linear regression estimated monthly trends; multivariable logistic regression estimated adjusted odds ratios (aORs) of outcomes for various SACT types.
Results: Among 68,963 patients, 18,337 (26.6%) received SACT at the EOL. From March 2015 to March 2020, use of SACT at the EOL increased (0.072% per month; P < .001), mainly driven by increased use of immunotherapy alone (0.064% per month; P < .001). Adjusted odds of high health services use and hospital death were more than two-fold greater among patients receiving SACT at the EOL (vs. none); individual aORs of high health services use and hospital death were 2.20 and 2.72 for chemotherapy alone, 2.36 and 3.10 for chemotherapy and immunotherapy, 1.92 and 2.27 for immunotherapy alone, and 1.75 and 2.37 for targeted therapy alone, respectively.
Conclusion: Use of SACT at the EOL increased significantly over time, driven by increased use of immunotherapy. SACT use at the EOL, regardless of its type, was associated with high health services use and hospital death. Guidelines on the use of SACT at the EOL should include novel cancer treatments.
Journal of Clinical Oncology , article en libre accès, 2025