Oral Anticancer Agents Linked With More Aggressive End-of-life Care

By Leah Lawrence - Last Updated: December 7, 2022

Patients with metastatic renal cell carcinoma (mRCC) who were younger and those who were being treated with oral anticancer agents (OAAs) received more aggressive end-of-life (EOL) care, according to a recent study published in JCO Oncology Practice.

Researchers retrospectively analyzed EOL care for decedents with mRCC from two patient groups. The first group was 410 patients diagnosed from 2004-2015 from the University of North Carolina’s Cancer Information and Population Health Resource (CIPHR). The second group was 1508 patients diagnosed from 2007-2015 from SEER-Medicare.

OAAs were assigned to 53.4% of patients in the CIPHR cohort and 43.5% of patients in the SEER cohort. In both groups, prior OAA use was significantly associated with increased systemic therapy in the last 30 days of life (CIPHR: 26.5% v 11.0%; P<.001; SEER-Medicare: 23.4% v 11.7%; P<.001).

“The use of systemic therapy near EOL has been shown not to improve quality of life, while subjecting patients to unnecessary toxicities,” the researchers wrote.

Prior OAA use was also associated with increased hospital death among patients in CIPHR and increased hospice use in the last 30 days in SEER-Medicare patients.

Prior use of OAA was not associated with inpatient admission in the 30 days prior to death. However, older patients were less likely to receive systemic therapy or to be admitted in the last 30 days, or to die in the hospital compared with younger patients.

Patients in the CIPHR cohort were more likely to die in the hospital if they had previously received an OAA.

In the SEER-Medicare group, prior OAA use was associated with increased use of hospice in the 30 days prior to death. However, those patients with dual Medicare and Medicaid had lower odds of hospice use in the 30 days before death compared with those patients with Medicare alone.

The researchers noted that lower quality EOL care was also seen in patients who were non-White race, male sex, from a rural location, from the northeast region, and those who had recurrent metastatic disease.

“Better understanding of the unique factors influencing physician and patient decision making around EOL care, particularly for patients receiving OAAs, warrants continuous evaluation to optimize EOL care,” the researchers concluded.

Source: Dzimotrowicz HE, Wilson LE, Jackson BE, et al. End-of-life care for patients with metastatic renal cell carcinoma in the era of oral anticancer therapy. JCO Oncology Practice. 2022;doi: 10.1200/OP.22.00401