463MO - Active treatment in final weeks of life: Importance of palliative care in advanced non-small-cell lung cancer

Background

Palliative care focuses on improving the quality of life and comfort of patients in the final stages of the disease by trying to provide relief from pain and other distressing symptoms by integrating physical, psychological and spiritual aspects. The main objective of this study is to evaluate the impact of palliative care on the use of active treatment in the last three weeks of life in patients with non-small cell lung cancer (NSCLC) and its impact on survival since the last cycle of treatment.

Methods

Bi-centre restrospecitve study. Includes 118 deceased patients who had been diagnosed with NSCLCm between 1/1/2019 and 30/4/2024. Patients had received at least one cycle of active treatment with chemotherapy, immunotherapy or both. Patients with druggable mutations in 1L were excluded. Statistical analysis was performed using SPSS version 28 software. The Kaplan-Meier method was used to estimate survival curves and the log-rank test was applied. Multivariate analysis was performed using the Cox regression method and binary logistic regression.

Results

OS from last cycle (LC) administration was 56 days in palliative care unit (PCU) assessed patients (95% CI 41.6-70.4) vs 27 days in non-PCU (95% CI 19.4-34.5) (p < 0.001); HR 3.23 (95% CI 2.01-5.13) (p < 0.001). In patients > 75 years, survival from LC was 66 days (95% CI 45.7-86.3) in those assessed by PCU vs 32 days (95% CI 26.3-37.7) in those not assessed (p < 0.001). In patients < 75 years, survival from LC was 56 days (95% CI 48.4-63.6) in those assessed by PCU vs 21 days (95% CI 11.5-30.5) in those not assessed (p < 0.001). In ECOG 2 patients, survival from the last cycle was 56 days in those who had been assessed by PCU (95% CI 42.9-69.1) vs 23 days (95% CI 19.5-26.5) in those not assessed (p < 0.001). In those who had been assessed for PCU, OR for treatment in the last three weeks of life was 0.20 (95% CI 0.07-0.57) (p 0.002). In those under 75 years of age, the OR was 2.83 (95% CI 1.03-7.72) (p 0.042).

Conclusions

Assessment by multidisciplinary teams including palliative care physicians has an important influence on the decision not to administer active treatment in the last three weeks of life in patients with advanced NSCLC. The greatest benefit is obtained in patients with an ECOG ≥ 2.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

University Hospital of Salamanca.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.