1396P - Increasing palliative interventions at the end of life: patterns in metastatic colorectal cancer (mCRC)

Date 10 September 2017
Event ESMO 2017 Congress
Session Poster display session
Topics Cancer in Adolescents
Palliative Care
Colon Cancer
Rectal Cancer
Palliative and Supportive Care
Presenter Rebecca Prince
Citation Annals of Oncology (2017) 28 (suppl_5): v497-v501. 10.1093/annonc/mdx382
Authors R. Prince1, A. Easson1, S. Liang2, M. Brar3, S. Ramkumar2, A. Scheer4, R. Wong5, J. Hallet6, C. Zimmermann7
  • 1Dmoh, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 2Dso, University of Toronto, Toronto/CA
  • 3Dso, Sinai Health System, Toronto/CA
  • 4Dso, St Michael's Hospital, Toronto/CA
  • 5Radiation Medicine Program, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA
  • 6Dso, Sunnybrook Health Sciences, Toronto/CA
  • 7Palliative Care, Princess Margaret Cancer Centre, M5G 2M9 - Toronto/CA

Abstract

Background

Advances in chemotherapy for mCRC have improved median survival to more than 24 months. This has resulted in increased opportunity to undergo more frequent interventions for symptom relief at the end of life. We explored patterns of palliative interventions (surgery, endoscopy, interventional radiology (IR), drainage procedures, radiotherapy) in mCRC patients over a time of evolving chemotherapy regimens.

Methods

A retrospective review was undertaken of all mCRC patients referred to palliative care at a tertiary cancer center in Toronto, Canada. Patients treated 2000-2004 (early cohort) were compared to 2006-2010 (later cohort) as more effective palliative chemotherapy was available in the later time period. Descriptive statistics, t-tests, and chi-squared tests were employed.

Results

A total of 542 (212 early and 330 later cohort) patients were included. Compared to the early cohort, the later cohort was significantly younger (62 vs 65 years, p = 0.012), had more Stage 4 disease (47 vs 42%, p = 0.029), fewer curative surgeries (58 vs 70%, p = 0.005) and fewer had adjuvant chemotherapy (26 vs 38%, p = 0.002). Palliative care referral was delayed for the later cohort with longer times between diagnosis of unresectability and referral (13 vs 8 mths, p = 0.0019) and shorter times between referral and death (6 vs 8 mths, p = 0.019). More patients in the later cohort had palliative surgery (31 vs 22%, p = 0.015), palliative IR procedures (15 vs 4%, p 

Conclusions

In their final months of life, palliative mCRC patients are undergoing more interventions requiring multi-disciplinary input with the aim of improving quality of life than previously. Increasing use of interventions in the last months of life has significant ramifications for patients, service provision, staffing and funding.

Clinical trial identification

Funding

PSI Foundation

Disclosure

All authors have declared no conflicts of interest.