30 day mortality for patients receiving palliative intent chemotherapy has been suggsted by the 2008 NCEPOD as a measure of quality of cancer care. This has to a number of global audits, with rates ranging from 8-43%. This world first prospective study aimed to benchmark an Australian tertiary cancer centre, and identify factors associated with 30 day mortality.
A Prospective cohort study of all patients with a diagnosis of malignancy referred for palliative intent intravenous chemotherapy to the Western Health Chemotherapy Day Unit from the 8th December 2014 to 8th December 2015. The primary outcome was death within 30 days of receiving palliative intent chemotherapy.
A total of 314 patients were enrolled in the study. The average age was 63 years, 45% were female, and 60% were born overseas. 98 patients died during the audit period. Of these, 21 (6.6%) died within 30 days of commencing palliative intent chemotherapy, and 60 (18.8%) died more than 30 days after receiving chemotherapy. Of the 34 patients that were referred, but did not start chemotherapy, 17 (52%) died. Multivariable logistic regression found that patients who had been referred to palliative care and received chemotherapy were more likely to die within 30 days, although this did not reach statistical significance. There was no difference in mortality rate by gender, age, tumour type, number of lines of previous chemothearpy, or patient performance status. Patient's who commenced chemotherapy were more likely to die in hospital (n = 44, 74%), as those who were referred but did not commence chemotherapy were more likely to die at home (n = 9, 50%). 199 patients ceased chemtoehrapy during the study period, with the most common reason being progression of disease (n = 78, 39.2%), and toxicity (n = 60, 30.2%).
This prospective cohort study demonstrated taht 6.6% of patients died within 30 days of administration of palliative intent chemotherapy. Multivariate analysis did not identify any pre-specified variables that were significantly associated with 30 day mortality. in our study, the strongest predictor of 30 day mortality was referral to outpatient palliative care.
Clinical trial identification
Legal entity responsible for the study
Western Central Melbourne Integrated Cancer Service.
All authors have declared no conflicts of interest.