1265MO - Cause and place of death in older patients with cancer: Results from a large cohort study using linked clinical and population-based data

Background

Limited data exists on end-of-life (EOL) health care utilization in older patients (pts) with cancer. Via data linkage, this study aims to describe EOL care for older pts with cancer and explore the association between geriatric screening and assessment (GS/GA) results at cancer diagnosis and EOL care.

Methods

Data linkage of GS/GA, cancer registry and administrative health data was performed based on a unique patient identifier. GS/GA data were derived from a large Belgian study (n=22 centers; 2009-2015) where pts aged ≥70 years were screened with G8 followed by GA in case of an abnormal G8 result (≤14/17). For this study pts with a new diagnosis were included when they died before end of follow-up (1/3/2019). Tumor characteristics and vital status were derived from cancer registry data and cause of death from death certificates. Place of death was derived from healthcare reimbursement data.

Results

4,475 pts who died after a median of 13 months were included. The median age was 79 (range: 70–100) and 52.0% were female. Lung, breast and colon cancer were the most common diagnoses and 40.5% had stage IV disease. 81.8% of pts had an abnormal baseline G8. For 81.0% of pts the underlying cause of death was cancer (Table). The majority of pts died in a non-palliative care unit of the hospital (42.3%), followed by at home (25.4%), the palliative care unit of the hospital (16.8%) and nursing home (15.5%). When comparing pts with a normal and abnormal baseline G8 score, there were no major differences in cause and place of death except for a higher percentage with abnormal G8 dying in a nursing home (16.9% vs 9.3%). Table: 1265MO

*most common: hearth failure, chronic obstructive pulmonary disease and acute myocardial infarction**place of death was considered home if the patient didn’t die in hospital or nursing home

Conclusions

When older pts with a new cancer diagnosis die in the following years, cancer is the underlying cause of death for >80%, both for pts with normal and abnormal baseline G8 score. The majority of pts die in a hospital and only a quarter of pts die at home. This knowledge is important for incorporation of advanced care planning within this patient population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Kom op tegen Kanker (Stand up to Cancer).

Disclosure

L. Decoster: Financial Interests, Institutional, Advisory Role: Bristol-Myers Squibb, AstraZeneca, Merck Sharp & Dohme; Financial Interests, Institutional, Speaker’s Bureau: AstraZeneca, Merck Sharp & Dohme; Financial Interests, Institutional, Travel: Roche Belgium, Merck Sharp & Dohme; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim. P.R. Debruyne: Financial Interests, Personal, Travel: Janssen; Financial Interests, Personal, Stocks/Shares: Alkermes, Biocartis; Financial Interests, Personal, Royalties: Bristol-Myers Squibb, Merck/Pfizer, MSD, Roche, Bayer; Financial Interests, Institutional, Research Grant: Pfizer. D. Bron: Financial Interests, Personal, Advisory Role: Abbvie; Financial Interests, Personal, Travel: Abbvie. V. Verschaeve: Financial Interests, Personal, Advisory Board: Janssen, MSD, Astellas Pharma. H.F.M. van den Bulck: Financial Interests, Personal, Advisory Role: AstraZeneca. J. Flamaing: Financial Interests, Personal, Advisory Role: Pfizer, GlaxoSmithKline; Financial Interests, Personal, Expert Testimony: Pfizer, GlaxoSmithKline. H. Wildiers: Financial Interests, Institutional, Advisory Board: Roche, Lilly, AstraZeneca, Daiichi Sankyo, PSI Cro AG, KCE, MSD, MSD, E Squared Communications LLC; Financial Interests, Institutional, Invited Speaker: Eisai, AstraZeneca; Financial Interests, Institutional, Consultancy fee: AbbVie, Immutep Pty; Financial Interests, Institutional, Expert Testimony: Daiichi-Sankyo; Financial Interests, Institutional, Consultancy: Daiichi Sankyo; Financial Interests, Institutional, Research Grant, Grant to the Leuven Breast Center to support the research database: Roche; Financial Interests, Institutional, Research Grant, Grant to institute to perform a multicentric national academic trial: Novartis; Travel & accomodations: Pfizer; Travel & accommodation: Roche; Subscription fee: Gilead. All other authors have declared no conflicts of interest.