Auclair Juline, Sanchez Stéphane, Chrusciel Jan, Hannetel Louise, Frasca Matthieu, Economos Guillaume, Habert-Dantigny Raphaelle, Bruera Eduardo, Burucoa Benoit, Ecarnot Fiona, Colombet Isabelle, Barbaret Cécile
Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France.
Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France.
Support Care Cancer. 2022 Jun;30(6):4997-5006. doi: 10.1007/s00520-022-06901-1. Epub 2022 Feb 22.
Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, but their use near the end of life in patients with advanced cancer is poorly documented. This study investigated the association between administration of ICI therapy in the last month of life and the duration of involvement of the palliative care (PC) team, among patients with advanced cancer who died in-hospital.
In a retrospective, multicentre study, we included all patients who died in 2018 of melanoma, head and neck carcinoma, non-small cell lung cancer or urothelial or renal cancer, in 2 teaching hospitals and one community hospital in France. The primary outcome was the association between ICI therapy in the last month of life and duration of involvement of the PC team in patient management.
Among 350 patients included, 133 (38%) received anti-cancer treatment in the last month of life, including 71/133 (53%) who received ICIs. A total of 207 patients (59%) received palliative care, only 127 (36%) 30 days before death. There was a significant association between ongoing ICI therapy in the last month of life and shorter duration of PC management (p = 0.04). Receiving ICI therapy in the last month of life was associated with an increased risk of late PC initiation by multivariate regression analysis (hazard ratio 1.668; 95% CI 1.022-2.722).
ICI therapy is frequently used close to the end of life in patients with advanced cancer. Innovative new anti-cancer treatments should not delay PC referral. Improved collaboration between PC and oncological teams is needed to address this issue.
免疫检查点抑制剂（ICIs）彻底改变了癌症治疗方式，但在晚期癌症患者生命末期使用此类药物的相关记录却很少。本研究调查了晚期癌症住院死亡患者在生命最后一个月接受ICI治疗与姑息治疗（PC）团队参与治疗的时长之间的关联。
在一项回顾性多中心研究中，我们纳入了2018年在法国2家教学医院和1家社区医院死于黑色素瘤、头颈癌、非小细胞肺癌、尿路上皮癌或肾癌的所有患者。主要结局是生命最后一个月接受ICI治疗与PC团队参与患者管理的时长之间的关联。
在纳入的350例患者中，133例（38%）在生命最后一个月接受了抗癌治疗，其中71/133例（53%）接受了ICIs。共有207例患者（59%）接受了姑息治疗，其中只有127例（36%）在死亡前30天接受了姑息治疗。生命最后一个月持续接受ICI治疗与PC管理时长较短之间存在显著关联（p = 0.04）。多因素回归分析显示，在生命最后一个月接受ICI治疗与PC启动延迟风险增加相关（风险比1.668；95%置信区间1.022 - 2.722）。
晚期癌症患者在生命末期经常使用ICI治疗。创新的新型抗癌治疗不应延迟PC转诊。需要改善PC团队与肿瘤学团队之间的协作以解决这一问题。
