Abstract 1274P
Background
Preventing overtreatment is a cornerstone of palliative care that aims to reduce treatment (tx) burden especially for cancer pts. ARTs are perceived as being better tolerated and with decreased tx burden compared to traditional chemotherapies. Despite this view, there is little research supporting the use of ART or describing EOL outcomes in mPC pts with reduced PS (ECOG >= 2).
Methods
We performed a retrospective study of 165 pts with mPC who received ART between 2010 and 2021 at our institution. We assessed each record for demographic and clinical information, ART course, and survival and EOL outcomes. Our primary aim was to compare overall survival (OS) between the groups and our secondary aim was to describe EOL outcomes. Fischer’s Exact Tests were used to compare baseline characteristics. Cox regression was used to compare OS for pts with ECOG >= 2 at the start of tx with those who had an ECOG of 0 or 1. Descriptive analyses were performed to assess EOL outcomes.
Results
Median age at ART start was 70.0 years (range 42.0 – 70.0). 10.3% of pts had a ECOG >= 2 and 13.9% were post-chemo. Median OS was 8.8 months in the ECOG >= 2 group and 49.4 in the < 2 group. (HR: 4.58 [2.49 – 8.45] p-value < 0.001). Variables significant (p-value <= .2) on univariate survival analysis included charlson comorbidity index, bone metastases, radical prostatectomy, hospitalization, and ADT during tx. On multivariate survival analysis adjusted for these possible confounders, ECOG >=2 remained significantly associated with OS (HR: 1.72 [1.28 – 2.31] p-value <.001). Relevant EOL Outcomes are reported in table below. Table: 1274P
| ECOG < 2 (N=57) | ECOG >= 2 (N=13) | Overall (N=70) | |
| Death in Hospital | |||
| Yes | 25 (43.9%) | 8 (61.5%) | 33 (47.1%) |
| Hospice Referral 30 Days Prior to Death | |||
| Yes | 39 (68.4%) | 6 (46.2%) | 45 (64.3%) |
| Supportive Care Consult 30 days Prior to Death | |||
| Yes | 39 (68.4%) | 6 (46.2%) | 45 (64.3%) |
Conclusions
Pts with mPC and decreased PS experienced shorter OS compared to those with higher PS . Moreover close to a majority of pts died in the hospital with a greater percentage among those with ECOG >=2. These findings highlight the need for improved shared decision-making in ART tx and further research exploring the association between PS and EOL care.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The Authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.