O'Sullivan H M, Conroy M, Power D G, Bambury R M, O'Mahony D, Collins D C, O'Leary M J, O'Reilly S
Department of Medical Oncology, Cork University Hospital, Cork, Ireland.
Department of Medical Oncology, Mercy University Hospital, Cork, Ireland.
J Palliat Care. 2025 Apr;40(2):147-151. doi: 10.1177/08258597221078391. Epub 2022 Feb 7.
Immune checkpoint inhibitors (ICIs) have less toxicity than standard chemotherapy and are now standard of care for many patients with advanced cancer. A manageable side effect profile and potential for durable responses may lead to aggressive care of the palliative patient. We sought to evaluate palliative care input and ICI use at the end of life at two Irish cancer centres. We identified deceased patients who received at least one dose of an ICI between first of January 2013 to 31 of December 2018. A retrospective electronic chart review was performed. The electronic records of 102 patients were analysed. Fifty eight percent were male and the median age of diagnosis of advanced disease was 60 years (range 17-78). Median time from last dose of ICI to death was 57 days (range 8-574) and 20% of patients died within 30 days of last dose of ICI. Most patients, 92%, were referred to palliative care. The median time from palliative care referral to death was 64 days (range 1- 1010). In the last 30 days of life, 39% of patients attended the emergency department (ED) and 46% had at least one hospital admission. Late palliative care referrals, ≤3 months before death, were associated with hospitalisations in the last month of life (64% vs. 36%, = .02). Timing of palliative care referral did not affect ICI prescribing at the end of life ( = 0.38). ICI use in the last 30 days of life was not associated with increased ED presentations or hospitalisations at the end of life. Patients who received ICI in the last month had a higher likelihood of in-hospital death (43% vs. 16%, = 0.02). ICI within 30 days of death was associated with dying in hospital but did not lead to more hospitalisations and emergency department presentations. Early palliative care did not affect ICI use but reduced hospitalisations at the end of life.
免疫检查点抑制剂（ICIs）的毒性低于标准化疗，现已成为许多晚期癌症患者的标准治疗方法。可控的副作用谱和持久反应的可能性可能导致对姑息治疗患者采取积极的治疗措施。我们试图评估爱尔兰两家癌症中心临终时姑息治疗的投入和ICIs的使用情况。我们确定了在2013年1月1日至2018年12月31日期间接受至少一剂ICIs的已故患者。进行了回顾性电子病历审查。分析了102例患者的电子记录。58%为男性，晚期疾病诊断的中位年龄为60岁（范围17 - 78岁）。从最后一剂ICIs到死亡的中位时间为57天（范围8 - 574天），20%的患者在最后一剂ICIs后的30天内死亡。大多数患者（92%）被转诊至姑息治疗。从姑息治疗转诊到死亡的中位时间为64天（范围1 - 1010天）。在生命的最后30天，39%的患者前往急诊科（ED）就诊，46%的患者至少有一次住院治疗。在死亡前≤3个月的晚期姑息治疗转诊与生命最后一个月的住院治疗相关（64%对36%，P = 0.02）。姑息治疗转诊的时间不影响临终时ICIs的处方（P = 0.38）。在生命的最后30天使用ICIs与临终时急诊就诊或住院治疗的增加无关。在最后一个月接受ICIs的患者院内死亡的可能性更高（43%对16%，P = 0.02）。死亡前30天内使用ICIs与在医院死亡相关，但不会导致更多的住院治疗和急诊科就诊。早期姑息治疗不影响ICIs的使用，但可减少临终时的住院治疗。
