Chemotherapy and immunotherapy in the final months of life: a retrospective cohort study in cancer patients.

PURPOSE: Chemotherapy and immunotherapy in the palliative phase are aimed at relieving cancer symptoms and prolonging survival, but may unintentionally affect quality of life. Determining the right time to switch to a comfort orientated approach without oncolytic therapies in the palliative phase can be a challenge. We examined the interval between the final systemic treatment with palliative intent and death, and explored associations with patient, tumor and treatment characteristics.

METHODS

We conducted a retrospective cohort study of consecutive adult patients with solid tumours who received intravenous palliative systemic treatment (chemotherapy, immunotherapy or chemo-immunotherapy) at a large teaching hospital between 2018 and 2023. Survival status, emergency department visits and hospital admissions were monitored through December 2023.

RESULTS

Of 1200 included patients, 922 died during the study period. Among those who died, 462 patients (50.1%) received systemic treatment in the last three months of life, including 243 patients (26.3%) treated within the final six weeks. Patients with a treatment-to-death interval of <3 months had significantly higher rates of emergency department visits, unplanned hospital admissions and in-hospital deaths than patients with an interval of >3 months. Younger age was significantly associated with receiving treatment in the final weeks of life.

CONCLUSION

Treatment with chemotherapy and immunotherapy is often continued during the final months of life. This approach is associated with more frequent emergency department visits, unplanned hospital admissions, and in-hospital death.