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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

4775 - Palliative chemotherapy for patient with advanced tumor and poor performance status: are oncologists’ hopes of benefit justified?

Date

22 Oct 2018

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

Topics

End-of-life Care

Tumour Site

Presenters

Vitor Vasconcellos

Citation

Annals of Oncology (2018) 29 (suppl_8): viii548-viii556. 10.1093/annonc/mdy295

Authors

V.F. Vasconcellos, R.R.C.C. Bonadio, G. Avanco, M.V. Negrão, R. Riechelmann

Author affiliations

  • Medical Oncology, ICESP - Instituto do Câncer do Estado de São Paulo, 01426-030 - Sao Paulo/BR
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Resources

Abstract 4775

Background

The recommendation to use palliative chemotherapy (PC) in patients (pts) with advanced cancer and poor performance status (ECOG-PS) is controversial and could be harmful. However, in routine practice some oncologists still recommend it. We sought to identify the outcomes and related prognostic factors of PC in these pts treated in a large academic cancer center.

Methods

We retrospectively reviewed all consecutive pts with poor ECOG-PS metastatic solid tumors who received PC during hospitalization for symptom control from January 2015 to September 2017. Eligible pts had ECOG-PS 3/4 and started first line PC or had ECOG-PS ≥2 and started second or further lines. Pts with known chemo-sensible tumors (germ cell, ovary, small cell lung cancer) and primary central nervous system were excluded. The primary end point was survival rate within 30 days from the date of first cycle. Logistic regression was used to identify prognostic factors associated with this mortality rate.

Results

We identified 228 consecutive pts. The median age was 56 years old, 133 pts (58%) were female, 150 pts (66%) were chemotherapy-naïve and almost half of pts had primary gastrointestinal tumors. 21.9%, 66.7% and 11.4% pts had ECOG-PS 2, 3 and 4, respectively. With a median follow-up of 49 days, 224 pts (98.2%) died. Nearly two thirds (N = 142) of pts died while hospitalized, with 31 (13.8%) dying while in ICU, 27 pts (12%) died in a hospice and 2 pts passed away at home. The median overall survival was 38.5 days and the survival rates within 30 and 60 days of chemotherapy were 55.7% and 38.5%, respectively. In the multivariate analysis, ECOG-PS 3/4 (OR 2.45; p = 0.015) and baseline values of anemia (OR 0.41; p = 0.034), hypercalcemia (OR 2.71; p = 0.410) and elevated total bilirubin level (5.14; p < 0.001) were significantly associated with 30-day mortality.

Conclusions

Most pts with advanced cancer and poor performance status clearly do not benefit from PC, especially those with ECOG-PS 3/4, hypercalcemia and elevated bilirubin. Transparent conversation with pts and their families about prognosis and the inefficiency of PC in this setting is crucial to avoid futile interventions.

Clinical trial identification

Legal entity responsible for the study

Comitê de Ética e Pesquisa ICESP - Instituto do Câncer do Estado de São Paulo.

Funding

Has not received any funding.

Editorial Acknowledgement

Disclosure

All authors have declared no conflicts of interest.

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