Associated factors regarding systemic anticancer therapy use prior to death among patients with metastatic non-small cell lung cancer: A multicentre retrospective cohort study.

BACKGROUND

Systemic anticancer therapy (SACT) near the end of life among patients with metastatic non-small cell lung cancer (NSCLC) is considered a population-level quality indicator of potentially inappropriate end-of-life care. We investigated factors associated with SACT in the final 6 weeks of life among patients diagnosed with metastatic NSCLC to optimise end-of-life care.

METHODS

A multicentre retrospective cohort study was conducted among patients with metastatic NSCLC across 7 hospitals in the Dutch Santeon network. Data were extracted from electronic health records. The primary outcome was the receipt of SACT (immunotherapy and/or chemotherapy) within 6 weeks before death. Variables included relevant demographics, clinical and tumour characteristics, palliative care team involvement, emergency department (ED) visits, and hospitalisations. A multivariable logistic regression with backward selection was employed to identify associated variables.

RESULTS

Among 365 included patients, 37 % received SACT in the last 6 weeks of life. Notably, these patients were significantly more likely to die in a hospital (44.1 % vs 9.6 %), to visit the emergency department (77.9 % vs 32.8 %) or to be hospitalised in the last 6 weeks of life (80.1 % vs 37.1 %). Hospitalisations before last treatment were independently associated with SACT use in the last 6 weeks of life (OR 2.673 (CI 1.317-5.427), p = 0.006) whereas ED visits were retained in the final model but were not statistically significant (OR 1.688, 95 % CI 0.861-3.311; p = 0.128).

CONCLUSION

This study highlights the importance of better understanding potentially inappropriate care near the end of life among patients with metastatic NSCLC, specifically when focusing on previous hospitalisations or emergency department visits.