Glisch Chad, Hagiwara Yuya, Gilbertson-White Stephanie, Gao Yubo, Lyckholm Laurel
Department of Medicine, Supportive and Palliative Care Program, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
College of Nursing, University of Iowa, Iowa City, IA, USA.
Am J Hosp Palliat Care. 2020 Mar;37(3):179-184. doi: 10.1177/1049909119862785. Epub 2019 Jul 15.
Immune checkpoint inhibitors have changed the landscape of cancer care by increasing progression-free and overall survival in some patients with cancer. We evaluated use and variables contributing to immune checkpoint inhibitor treatment near the end of life.
We studied 157 patients who received immune checkpoint inhibitors and died between January 2015 and December 2018. All patients had a palliative care consult any time between starting an immune checkpoint inhibitor and death. Univariate and multivariate models were used to examine variables related to immune checkpoint inhibitor use near the end of life.
Among 157 patients studied, 42 (27%) received a dose of immune checkpoint inhibitor in the last 30 days of life. Those who received treatment in the last 30 days of life had lower hospice enrollment (19 [45%] vs 78 [69%], = .007) and higher rates of dying in the hospital (23 [56%] vs 33 [29%], = .002). The percentage of patients with Eastern Cooperative Oncology Group (ECOG) ≥3 at the time of last immune checkpoint inhibitor dose was higher in the group that received immune checkpoint inhibitor treatment in the last 30 days of life (11 [26%] vs 9 [8%], = .003). Lack of traditional chemotherapy after immune checkpoint inhibitor, ECOG ≥3, and lack of hospice enrollment were independently associated with receiving immune checkpoint inhibitor in the last 30 days of life.
Immune checkpoint inhibitor use in the last 30 days of life is common and associated with poor performance status, lower hospice enrollment, and dying in the hospital.
免疫检查点抑制剂通过提高部分癌症患者的无进展生存期和总生存期，改变了癌症治疗的格局。我们评估了临终时免疫检查点抑制剂治疗的使用情况及相关变量。
我们研究了157例接受免疫检查点抑制剂治疗并于2015年1月至2018年12月期间死亡的患者。所有患者在开始免疫检查点抑制剂治疗至死亡期间的任何时间都接受了姑息治疗咨询。采用单因素和多因素模型来检查与临终时免疫检查点抑制剂使用相关的变量。
在研究的157例患者中，42例（27%）在生命的最后30天接受了一剂免疫检查点抑制剂。在生命的最后30天接受治疗的患者临终关怀登记率较低（19例[45%]对78例[69%]，P = 0.007），且在医院死亡的比例较高（23例[56%]对33例[29%]，P = 0.002）。在生命的最后30天接受免疫检查点抑制剂治疗的组中，末次免疫检查点抑制剂给药时东部肿瘤协作组（ECOG）≥3的患者百分比更高（11例[26%]对9例[8%]，P = 0.003）。免疫检查点抑制剂治疗后未进行传统化疗、ECOG≥3以及未登记临终关怀与在生命的最后30天接受免疫检查点抑制剂独立相关。
在生命的最后30天使用免疫检查点抑制剂很常见，且与身体状况不佳、临终关怀登记率较低以及在医院死亡有关。
