Advanced cancer patients (ACP) with poor PS often get systemic anticancer treatment (SAT). A combined PC and medical oncology structured approach involving double boarded palliative oncologists (PallOnc) is investigated.
Medical chart review over 2½ years, with locally developed (adapted from Blum D JPSM 2014) tool, of all ACP PS > 1 in a tertiary PC unit (330 pts/year, death rate 40%, length of stay [LOS] 12 days) receiving intravenous SAT (pharmacy orders). ACP with new initiated SAT were compared with continued SAT for tumor history, PS, and outcomes; in new SAT the PallOnc processes decisional process, Palliative Interventions (PIs), and primary dose reduction were analysed.
Of 95 ACP receiving SAT 65 (68%) were PS > 1. In 36 ACP a new SAT was initiated, in 29 continued. Comparable were age (years, mean: 65 vs 63), gender (% female: 39 vs 43), PS (PS3/4: 64% vs 65%)), time since diagnosis of stage 4 (months, mean: 16 vs 14), number of anticancer treatment lines (mean: 2 vs 2) and LOS (days, mean: 26 vs 24). New vs continued SAT differed for tumors not responding (never PR or SD) to last chemotherapy (55% [7 PS2, 4 PS3] vs 27% [1 PS2, 2 PS3], monotherapies (67% vs 45%), death at PC unit (14% vs 41%), overall survival (1 patient alive, 1 lost-to-follow-up; days, median: 83 vs 58, mean 152 vs 128), PS at demission compared to admission (stable PS: 33% vs 24%; improved PS: 50% vs 24%), and ACP who died ≤14 days after last SAT (22% vs 14%). No G3/4 non-hematological toxicity was reported. In the new SAT group the decisional process took 11 days (median, range 0-48), explicit goals of SAT were documented in 81% (44% specific tumour-related symptoms), attitude towards SAT in 86% ACP (unwilling, ambiguous 4/31, wants, imperative 17) and 42% physicians (0, 15). Of 5 PIs Illness understanding, symptom control, end-of-life preparation, network & family support, spiritual needs) all were delivered in 21 ACP (58%), 4 and 3 in 7, 2 in 1. Primary dose reduction was applied in 2/4 PS4 patients (1: 5-25%,1: 26-50%), 13/19 PS3 (5, 8) and 11/13 PS2 (7, 4) ACP.
In a setting with PallOnc anticancer treatment in poor PS patients seems feasible. The encouraging data may foster prospective research.
Clinical trial identification
Legal entity responsible for the study
Cantonal Hospital St.Gallen, Switzerland
All authors have declared no conflicts of interest.