Abstract 4541
Background
Patients (pts) with advanced cancer have high rates of healthcare resource utilization at the end of life (EOL). Immunotherapy (IO) has changed the treatment landscape for many patients with cancer. The impact of IO on resource utilization at the EOL for pts with metastatic disease, including emergency department (ED) visits, hospitalizations, and referrals to hospice is unknown.
Methods
We conducted a single center, retrospective analysis of pts treated with PD-1/L1 or CTLA-4 antibodies alone or in combination from 2011 – 2017. We identified 1,113 pts from electronic health records and present here clinical information for 306 pts with metastatic disease and end of life outcome data for 188 decedents. Survival curves were compared using log-rank test for pts by disease, treatment type, ECOG performance status (PS) at treatment start, and age. Hospice referral rate was compared using Fisher’s exact test.
Results
Of the 306 pts, 131 (43%) had melanoma, 42 (14%) had renal cell carcinoma, 33 (11%) had non-small cell lung cancer, 22 (7%) had head and neck carcinoma, and 78 (25%) had another advanced malignancy. Treatment consisted of nivolumab in 130 (42%) pts, ipilimumab in 73 (24%), pembrolizumab in 59 (19%), nivolumab/ipilimumab in 23 (8%), atezolizumab in 9 (3%), and other IO combinations in 12 (4%). Of the 188 (61%) pts who died, 93 (49%) had at least one ED visit in the last month of life, 110 (59%) had at least one hospitalization, and 21 (11%) died in the hospital. Of all pts who died, 156 (83%) had hospice referral with a median of 11 days (range 1-420) between hospice referral and death. Overall survival (OS) was not associated with disease type (p = 0.11) or treatment (p = 0.832), but was associated with ECOG PS (p = 0.013). Referral to hospice did not vary by disease type (p = 0.945), treatment type, (p = 0.809) or age (p = 0.432), but did vary by ECOG PS (p = 0.006). Death within 72 hours of hospice referral rate varied significantly by inpatient or outpatient referral (p = 0.002).
Conclusions
Hospitalizations and ED visits are frequent at the EOL among pts who received IO for advanced malignancies. There was a high referral rate to hospice, but the median time between hospice referral and death was short. Interventions to decrease aggressive EOL care are needed.
Clinical trial identification
Legal entity responsible for the study
Jarred Burkart.
Funding
Has not received any funding.
Editorial Acknowledgement
Disclosure
A.M. Noonan: Paid member of a data safety monitoring board from 2016-2017: Helsinn. All other authors have declared no conflicts of interest.
Resources from the same session
2595 - Real-Life Utilization of Genomic testing for invasive Breast Cancer patients in Italy and France reduces Chemotherapy Recommendations
Presenter: Sandro Barni
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2343 - Benefit of adjuvant chemotherapy in hormone receptor-positive, HER2-negative, invasive lobular carcinoma of the breast
Presenter: Alexandre De Nonneville
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2990 - Baseline lymphocyte counts predict distant recurrence in early breast cancer
Presenter: Gun Min Kim
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4532 - A propensity score analysis exploring the impact of the addition of adjuvant chemotherapy (aCT) to hormone therapy (aHT) in a multi-center series of resected luminal early stage pure Invasive Lobular Breast Carcinoma (ILC).
Presenter: Luisa Carbognin
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
2344 - Benefit of Adjuvant Systemic Therapies in HR+ HER2- pT1ab Node-Negative Breast Carcinomas
Presenter: Alexandre De Nonneville
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3525 - Anti-proliferative effect of oral metronomic vinorelbine in PAM50 Luminal/HER2-negative early breast cancer (SOLTI-1501 VENTANA): an open-label, randomized, three-arm, multicenter, window-of-opportunity study
Presenter: Aleix Prat
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3908 - Clinicopathologic significance of androgen receptor expression and discordant receptor status during progression in breast cancer
Presenter: Chan Heun Park
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
4075 - The outcomes of early breast cancers utilizing the Oncotype Dx Recurrence score (RS) instead of Clinico-pathological (CP) factors for prognostic risk assessment: A Single Institution Experience
Presenter: Adhar Alsayed
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
738 - Circulating tumor cells as a prognostic marker in non metastatic breast cancer patients.
Presenter: Summar Elmorshidy
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract
3151 - Molecular subtyping of breast cancer by dedicated breast PET
Presenter: Satoshi Sueoka
Session: Poster display session: Breast cancer - early stage, locally advanced & metastatic, CNS tumours, Developmental therapeutics, Genitourinary tumours - prostate & non-prostate, Palliative care, Psycho-oncology, Public health policy, Sarcoma, Supportive care
Resources:
Abstract