Advances in cancer therapies increase survival in non-curable cancers, impacting quality of life and healthcare resource utilization. This study aims to determine treatment aggressiveness near the end of life (EoL) and estimate direct medical costs.
We evaluated aggressiveness near the EoL in 560 patients (pts) with advanced solid cancer (breast, prostate, colon or lung) at a Portuguese Comprehensive Cancer Centre, who died during 2017. Descriptive statistic was used to access clinical-pathological characteristics; proportion of pts who received systemic treatment in the last 3 months (Cohort 1 (Ch1), N=298) or best supportive care (BSC) (Cohort 2 (Ch2), N=262); median of days between last cycle and death; admission in the emergency room (ER) or hospitalization. Direct costs of unscheduled health resources (UHR) were calculated (outpatient tests and exams excluded). Factors influencing treatment choice were evaluated using logistic regression models.
Lung was the most prevalent cancer in both cohorts (Ch1 47% vs Ch2 49%) followed by breast in Ch1 (30%) and colon in Ch2 (27%). In Ch1, 141 pts (47%) received systemic treatment in the last month and 70 (23%) in last 2 weeks of life, with breast cancer being the leading group (p<0.001). Median of days between last cycle and death was shorter for lung and breast cancer and higher for prostate cancer pts (29 vs 46, p<0.001). Better performance status (PS), younger age and other malignant disease than colon cancer were associated with increased odds of receiving systemic treatment near the EoL. The proportion of patients admitted in the ER and hospitalized was high and similar in both cohorts (81% and 79% vs. 74% and 76%, respectively). Average cost of UHR was higher in Ch1 (3219€) when compared to Ch2 (2868€), although not significantly (p=0.170).
We found a trend towards greater aggressiveness near the EoL in pts with breast cancer, followed by prostate and lung cancers. Moreover, younger pts and better PS were more likely to receive systemic treatment in the last 3 months of life, representing higher UHR costs. We conclude that earlier access to BSC is needed to minimize aggressiveness near the EoL.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.